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Full text of "Medical aspects of nuclear weapons and their effects on medical operations : subcourse MED447"

DOC, 

D 101.2: 
JM46/6 



JUN 26 






1991 



py SCIENCES, % 
US ARMY 



Op 



FORT SAM HOUSTON, TEXAS 78234 



MEDICAL ASPECTS OF NUCLEAR WEAPONS 



AND THEIR EFFECTS ON 



MEDICAL OPERATIONS 




SUBCOURSE MED447 



JUNE 1990 



DEVELOPMENT 

This subcourse is approved for resident and correspondence course instruction. 
It reflects the current thought of the Academy and conforms to printed Depart- 
ment of the Army doctrine as closely as currently possible. Development and 
progress render such doctrine continuously subject to change. 

The education specialist responsible for revision of this edition was James F. 
Legendre, AUTOVON 471-3873 or commercial phone (512) 221-3873; Commandant, 
Academy of Health Sciences, ATTN: HSHA-TCC, Fort Sam Houston .Texas 
78234-6100. 

The subject matter expert responsible for content accuracy of this edition was 
the NBC Science Branch of the Preventive Medicine Division, AUTOVON 471-6011 
or area code 512-221-6011, Academy of Health Sciences, ATTN: HSHA-IPM, Fort 
Sam Houston, Texas 78234-6100 

The editorial assistant for this edition of the subcourse was John L. 
Mc I ntosh. 



ADMINISTRATION 

For comments or questions regarding enrollment, student records, or shipment 
of subcourses, contact the Extension Services Division, Monday through 
Friday beteeen 0730 and 1230 hours, Central Time, at AUTOVON 471-6877. 
Toll— free numbers are: in Texas, 1—800—292—5867 (extension 6877); outside 
Texas, 1—800—531—1114 (extension 6877); Commandant, Academy of Health 
Sciences, ATTN: HSHA-IES, Fort Sam Houston, Texas 78234-6199. 



CLARIFICATION OF TRAINING LITERATURE TERMINOLOGY 

When used in this publication, words such as "he," "him," "his," and "men" are 
intended to include both the masculine and feminine genders, unless 
specifically stated otherwise or when obvious in context. 



Lesson 






INTRODUCTION 

REVIEW OF NUCLEAR WEAPON EFFEC", 

Section I. Principles of Nuc 

Section II. Nuclear Blast.... 

Section III. Thermal and Initi 

Section IV. Residual Ionizing 



CENTRAL CIRCULATION AND BOOKSTACKS 

The person borrowing this material is re- 
sponsible for its renewal or return before 
the Latest Date stamped below You may 
be charged a minimum fee of $75.00 tor 
each non-returned or lost item. 

TABLE OF ^.ft, ^...a.ion, or defacement of library «jj«^ J' 
1,., for „uden. **M «•■" ■ « "* J* ~ " ,a,e 
th . University of ....no., I Lfcrary ~e * ^ j£ 
of Illinois and are protected by Article iod 
Law and Procedure. 

TO RENEW, CAU 1217) 333-8400. 
University of Illinois library at Urbana-Champaign 



Exerc ises 

IONIZING RADIATION INJURY 
Exerc ises 



apr o z m 

23282 

MAY 2 5 2004 



Page 
i i i 

-2 
-13 
-29 
-32 

-44 

-2 

-14 



COMPARATIVE EFFECTS OF NUCLEAR V 
RADIATION DOSE AND DECAY CALCUL/ 
MANAGEMENT OF MASS CASUALTIES 

Section I. Comparative Effect 

Weapons 2 

Section II. Residual Radiation 

Calcu lat ions. ... 3 

Sect ion III. Management of Mass When ren ewing by phone, write new due date , 

below previous due date. 
Exerc ises | !9 

COMMAND GUIDANCE ON IRRADIATED PERSONNEL AND NUCLEAR 
ACCIDENTS AND INCIDENTS 



Command Guidance on Irradiated 

Personne I 

Nuclear Accidents and Incidents. 



Sect ion I . 
Sect ion II. 

Exerc ises 

MEDICAL OPERATIONS IN FALLOUT 



4-1 — 4-7 
4-8—4-12 



4-2 
4-13 

4-19 



Sect ion 
Sect ion 



I I 



Background 

Problem Si tuat ion 



Exerc ises 

APPENDIX A (GR 76-332-100) 

GLOSSARY OF TERMS) 

EXAMINATION 



5-1—5-8 


5-2 


5-9 — 5-24 


5-12 




5-29 




A-1 




G-1 




EXAM-1 



MED447 



DEVELOPMENT 

This subcourse is approved for resident and correspondence course instruction. 
It reflects the current thought of the Academy and conforms to printed Depart- 
ment of the Army doctrine as closely as currently possible. Development and 
progress render such doctrine continuously subject to change. 

The education specialist responsible for revision of this edition was James F. 
Legendre, AUTOVON 471-3873 or commercial phone (512) 221-3873; Commandant, 
Academy of Health Sciences, ATTN: HSHA-TCC, Fort Sam Houston .Texas 
78234-6100. 

The subject matter expert responsible for content accuracy of this edition was 
the NBC Science Branch of the Preventive Medicine Division, AUTOVON 471-6011 
or area code 512-221-6011, Academy of Health Sciences, ATTN: HSHA-IPM, Fort 
Sam Houston, Texas 78234-6100 

The editorial assistant for this edition of the subcourse was John L. 
Mc I ntosh. 



ADMINISTRATION 

For comments or questions regarding enrollment, student records, or shipment 
of subcourses, contact the Extension Services Division, Monday through 
Friday beteeen 0730 and 1230 hours, Central Time, at AUTOVON 471-6877. 
Tol I— free numbers are: in Texas, 1—800—292—5867 (extension 6877); outside 
Texas, 1—800—531—1114 (extension 6877); Commandant, Academy of Health 
Sciences, ATTN: HSHA-IES, Fort Sam Houston, Texas 78234-6199. 



CLARIFICATION OF TRAINING LITERATURE TERMINOLOGY 

When used in this publication, words such as "he," "him," "his," and "men" are 
intended to include both the masculine and feminine genders, unless 
specifically stated otherwise or when obvious in context. 






TABLE OF CONTENTS 

Lesson Paragraph Page 

I NTRODUCT I ON i i i 

1 REVIEW OF NUCLEAR WEAPON EFFECTS 

Section I. Principles of Nuclear Weapons 1-1 — 1-7 1-2 

Section II. Nuclear Blast 1-8 — 1-15 1-13 

Section III. Thermal and Initial Radiation 1-16 — 1-17 1-29 

Section IV. Residual Ionizing Radiation 1-18 — 1-22 1-32 

Exerc ises 1—44 

2 IONIZING RADIATION INJURY 2-1 — 2-11 2-2 

Exercises 2—14 

3 COMPARATIVE EFFECTS OF NUCLEAR WEAPONS; RESIDUAL 
RADIATION DOSE AND DECAY CALCULATIONS, AND 
MANAGEMENT OF MASS CASUALTIES 

Section I. Comparative Effects of Nuclear 

Weapons 3-1 — 3-5 3-2 

Section II. Residual Radiation Dose and Decay 

Ca I cu I at i ons 3-6 — 3-1 1 3-8 

Section III. Management of Mass Casualties 3-12 — 3-18 3-20 

Exerc ises 3-29 

4 COMMAND GUIDANCE ON IRRADIATED PERSONNEL AND NUCLEAR 
ACCIDENTS AND INCIDENTS 

Section I. Command Guidance on Irradiated 

Personne I 4-1 — 4-7 4-2 

Section II. Nuclear Accidents and Incidents.... 4—8 — 4—12 4—13 

Exercises 4-19 

5 MEDICAL OPERATIONS IN FALLOUT 

Sect ion I . Background 5—1 — 5—8 5—2 

Section II. Probl em S i tuat ion 5-9 — 5-24 5-12 

Exerc i ses 5-29 

APPENDIX A (GR 76-332-100) A-1 

GLOSSARY OF TERMS) G-1 

EXAM I NAT I ON EXAM-1 

MED447 i 



LIST OF FIGURES 



F i gure 



Page 



1-1 Distribution of energy 1-16 

3-1 ABC-M1 rad i ac ca I cu I ator 3-11 

3—2 Decay of radioactive fallout 3—12 

3—3 Normalizing survey data 3—13 

3—4 Dose absorbed by personnel 3—14 

5—1 Simplified fallout predictor, field construction 

(not drawn to scale) 5-1 1 



LIST OF TABLES 



Table 



Page 



1 — 1 Compar ison of effects of psi 1 — 19 

2—1 Radiation dose effect relationship 2-5 

3-1 Casualty criteria for personnel exposed to prompt effects... 3-2 

3—2 Comparison of weapon effects (airbursts) 3—3 

3—3 Emergency medical treatment procedures 3—28 

4—1 Physical effectiveness required to perform typical combat 

tasks 4-3 

4-2 Acute dose 4-10 

4-3 Operations exposure guide 4—11 



MED447 



i i 



CORRESPONDENCE COURSE OF 
THE ACADEMY OF HEALTH SCIENCES, U.S. ARMY 

SUBCOURSE MED447 

MEDICAL ASPECTS OF NUCLEAR WEAPONS AND THEIR EFFECTS ON 

MEDICAL OPERATIONS 

INTRODUCTION 



Nuclear weapons may have a tremendously devastating effect, but by no 
means are they the ultimate in weapons. In fact, much can be done to defend 
aga i nst these weapons and still ma i nta i n some ab i I i ty to cont i nue mi I i tary as 
well as national operational functions. Of course, this is more true for 
those effects which we have classified and you know as residual, when compared 
to the immediate or prompt effects. Survival of large population segments, 
which have survived the prompt effects, can be ensured by proper shelter from 
fallout or the residual effects. Because the post— attack environment requires 
an aspect of nuclear medical responsibility be employed in medical services 
and the other residual reserves to obtain optimum results, a knowledge of the 
operational characteristics and post— attack tasks must be absorbed prior to 
the event and capabilities developed and exercised for medical support. 

On the integrated battlefield, the Army Medical Department will be 
expected to continue medical support operations and to treat large numbers of 
nuclear casualties despite the enormous capabilities of nuclear weapons to 
wreak havoc upon and within military units and personnel. This expectation 
alone forebodes a tremendous undertaking. In addition, attention must be 
given to another aspect of the nuclear medical responsibility, which, in the 
final analysis, may be every bit as important a contribution to the support of 
the Army's combat mission. This is the time— honored responsibility of the 
medical officer for advising the commander on all medical problems pertaining 
to the health of his command. 

Ionizing radiation is important to the military commander because of its 
effect on people. This means that the commander should, does, and will look 
to his surgeon for advice on the effects of radiation exposure. But because 
of the insidious nature of these radiation effects, and limitations in the 
present knowledge of radiation effects and associated technology, radiation 
guidance becomes an exceedingly challenging responsibility for the surgeon and 
h is staff . 

Conservation of manpower, without question, will be of great concern in 
any mass casualty situation, and especially so, in a nuclear situation. The 
basic problem that the medical service faces in planning for mass casualty 
situations is not the type of injuries to be expected, or a lack of experi- 
ence, or dispersion of the units, but rather the large numbers of casualties 
requiring treatment that will occur at almost the same instant. One phase of 
the problem visualized at this time is the training of the individual soldier 
to take care of himself (self-aid) and of his associates (buddy— aid) until 
medical assistance can be made available. Another phase of the problem lies 

MED447 i i i 



in the decisions made by the commander in his consideration of the casualties 
and the tactical situation. The commander must constantly weigh the ever 
increasing health hazards against the demands of the tactical situation. This 
is a difficult problem for any commander but the more he knows and has thought 
of his potential problems in a possible mass casualty situation, the better 
his decisions will be when faced with the actual situation. 

This subcourse is directed toward the medical effects of nuclear weapons; 
command guidance on irradiated personnel; medical management of mass 
casualties with a view toward minimizing manpower damage and preventing 
unnecessary loss of personnel capable of continuing their military mission; 
effective command, control, and employment of medical units in the post- 
attack environment; and actions to be taken by the military, in this case, 
specifically the medical units, in order to preclude and defend against the 
tremendous residual effects of nuclear warfare. The ability to perform under 
such conditions can be attained through effective command, control, and 
employment of the medical units after the nuclear explosion. 

This subcourse consists of 5 lessons and an examination. The lessons are: 

Lesson 1, Review of Nuclear Weapon Effects. 

Lesson 2, Ionizing Radiation Injury. 

Lesson 3, Comparative Effects of Nuclear Weapons; Residual Radiation 
Dose and Decay Calculations; and Management of Mass Casualties. 

Lesson 4, Command Guidance on Irradiated Personnel and Nuclear Accidents 
and Incidents. 

Lesson 5, Medical Operations in Fallout. 

Exami nat i on 

You will be awarded 21 credit hours for the successful completion of 
this subcourse. 

Text and materials furnished: 

Subcourse MED447, May 1990. 

Map Helotes, 1:50,000, Sheet 6243 II, series V782, Edition 1-DMATC, 
Stock No. V782X62532. 

Overlay, Simplified Fallout Predictor. 

Calculator Set, Radiac, ABC-M1 (printed on inside of rear cover). 

No other materials are required. 

YOU MAY RETAIN THE STUDY MATERIALS. 

MED447 iv 



No mail— in answer sheets are provided for the lessons in this subcourse 
because you are to grade your own lessons. The lesson exercises and solutions 
for all lessons are contained in this booklet. You are encouraged to complete 
the subcourse I esson— by— I esson. 

You will submit your examination answer sheet to the Academy for grading. 

WE SUGGEST THAT YOU FOLLOW THESE STUDY PROCEDURES: 

— Read and study each lesson assignment carefully. 

— REFER TO THE GLOSSARY EXPLAINING THE MANY ACRONYMS AND SPECIFIC TERMS 
FOUND THROUGHOUT THE LESSONS. 

— Read again through the text material, completing unanswered exercises 
and correcting others as needed. 

— When you have completed the exercises to your satisfaction, compare your 
answers to the ones on the solution sheet located at the end of the 
lesson. Check the references for your incorrect answers. 

— After you have successfully completed one lesson go on to the next and 
repeat the above procedures. 

— Complete the examination answer sheet and mail it to us for grading. 
The grade you make on the examination will be your rating for the 
subcourse . 

— No postage is required. 

A Student Comment Sheet is located in the back of this booklet. It is to 
be returned with your examination answer sheet. As you study the subcourse 
you may wish to make notes of suggestions or criticisms and write them on the 
comment sheet after you have completed the examination. 



MED447 



Digitized by the Internet Archive 

in 2012 with funding from 

University of Illinois Urbana-Champaign 



http://archive.org/details/medicalaspectsofOOacad 



LESSON 1 

LESSON ASSIGNMENT 
MATERIALS REQUIRED 
LESSON OBJECTIVES 



SUGGESTION 



LESSON ASSIGNMENT SHEET 
--Review of Nuclear Weapon Effects. 
— Paragraphs 1 — 1 — 1—22 . 
— None . 

--After completing this lesson, you should be able to: 

1—1. Describe a brief history of the development of 
the nuclear bomb. 

1—2. Discuss the principles of a nuclear detonation. 

1—3. Describe blast, thermal, initial radiation, and 
residual ionizing radiation. 

--After completing the assignment, complete the 

exercises at the end of this lesson. These exercises 
will help you to achieve the lesson objectives. 



MED447 



1-1 



LESSON 1 
REVIEW OF NUCLEAR WEAPON EFFECTS 

Section I. PRINCIPLES OF NUCLEAR WEAPONS 



1-1 . DEVELOPMENT OF NUCLEAR WEAPONS 

As an introduction to nuclear weapons and their effects, it is most 
interesting to consider the succession of small, but yet significant, dis- 
coveries in nuclear physics which contributed toward the initial nuclear 
detonation at Trinity Site, Alamogordo, New Mexico. For this story, one might 
conceivably begin back about 2,000 years ago when Democr i tus taught that all 
matter consisted of tiny indivisible particles called atoms, or atomos, 
mean i ng i nd i v i s i b I e . 

a. The most significant contribution during the 19th century occurred 
in 1896 when nuclear radiation was discovered by Antoine Henri Becquerel while 
he was using uranium oxide and photographic plates; but, most of the specific 
work in nuclear physics was done in the 20th century. One could say that it 
all started in 1905 when Einstein proposed the theory that energy and mass 
were convertible and related by the formula E = mc 2 . In 1910, Ernest 
Rutherford discovered the alpha particle. In 1931, Sir James Chadwick, who 
was later to head the British Atomic Mission to the United States, discovered 
the neutron when he bombarded beryl I i urn with the alpha particle discovered by 
Rutherford. In 1934, Enrico Fermi, while bombarding uranium atoms with the 
newly discovered neutron of Chadwick, unknowingly split the atom producing the 
first artificial transmutation. Also, that year Professor Harold Urey won the 
Nobel Prize in chemistry for his isolation of heavy hydrogen which is 
important to the fusion process in thermonuclear weapons. In 1935, Dr. Niels 
Bohr won the Nobel Prize in physics for postulating the internal configuration 
of the atom. 

b. It is interesting to speculate on the probable success of the 
Germans in their development of a nuclear weapon had not their political doc- 
trines intervened. Of particular note was the case of Dr. Lise Meitner, who, 
while working with the German physicists Hahn and Strausmann at the Kaiser 
Wilhelm Institute, explained the phenomenon of Dr. Fermi's experiments of the 
fissioning of the uranium atom. Had she been able to explore and convey to 
the German government at this time the significance of the experiments, the 
final outcome of the war may have been changed. But she fled Nazi Germany 
after learning of Heinrich Himmler's exclusion act because she was Jewish. 
Later, Otto Hahn won a Nobel Prize in chemistry for enlargements on her work. 

c. In 1939, Dr. Fermi, while working at Columbia University, after 
fleeing his native Italy because of possible retaliation for his antifascist 
views, went to the United States mi I i tary to explain the poss i b i I i ty of the 
new explosive power he now understood to be released in the process of 
fissioning. But at this time this concept was something out of "Twilight 
Zone," and he got the reply "don't call us, we'll call you." Later that year 

MED447 1-2 



Alexander Sachs carried a letter, composed by Albert Einstein and formulated 
by a group of scientists knowledgeable in the weapon's potential of the sci- 
entific discovery, to President Franklin D. Roosevelt. However, several 
precious months were lost while Sachs waited to gain admission to Roosevelt's 
office. In all America at this time, there was less than one ounce of 
metallic uranium. Also, even at this early development stage, Russia picked 
up the wind of the possibility of the production of such an "atomic bomb." 

d. In August 1940, Edgar Sengier, director of Belgium's uranium mines 
located in the Belgian Congo, contemplated his country's control by the Nazis 
and quietly shipped 1,200 tons of high grade uranium in 2,000 steel drums to 
Staten Island, New York. The U.S. authorities were notified but the records 
were mislaid, and for two years the uranium lay undiscovered in a Staten 

Island warehouse. 

e. In 1941, at a top level committee meeting, Dr. Kenneth Bainbridge, 
a Harvard physics professor, discussed the possibility of military applica- 
tion of a uranium detonation. But late in the year no chain reaction had been 
made, no appreciable amount of 238 U had been separated from the more abundant 
23e U, and only minute amounts of plutonium had been produced by Dr. Glenn 
Seaborg of the University of California. However, during the year, the first 
controlled chain reaction was produced by Dr. Fermi in the Stagg Field stadium 
stands at the University of Chicago. In December, Dr. Vannevar Bush, head of 
the Office of Scientific Research and Development, was appointed to determine 
the feasibility of making such a nuclear weapon. 

f. In August 1942, the Manhattan Engineering District was formally 
established. In September, Colonel Leslie Richard Groves took over the newly 
designated Manhattan Engineering project. Colonel Groves was a graduate of 
West Point, the Command and General Staff School, and the Army War College. 

He had served as deputy chief of construction in building the Pentagon, and he 
was promoted to the grade of brigadier general on 6 September 1942. One of 
Colonel Groves' deputies located the 1,200 tons of uranium ore at Staten 
Island. Colonel Groves hired Dr. Robert Oppenheimer to be his deputy and to 
direct the laboratories that were to build the bomb. Though $100 million was 
initially allocated for the weapon's production, this was to grow into $2.3 
billion. During this time it was decided that Oak Ridge, using the gaseous 
diffusion process, would produce the 238 U needed for the gun assembly weapon 
while the Hanford, Washington, plant would use the Seaborg process to produce 
pi uton ium. 

g. In August, 1943, Roosevelt and Churchill signed an agreement for 
British scientists to work at Los Alamos and Oak Ridge, with the U.S. 
accepting British security clearances. Among them was Dr. Klaus Fuchs, a 
German who had joined a Communist youth organization in the early 1930's and 
subsequently was beaten up at a Nazi youth rally during the Nazi takeover of 
Germany. This had reinforced his Communist sympathies. He later received 
doctorates in both mathematics and science from Bristol and Edinburg 
Universities. While in Canada, he was interned as a hostile alien, but he 
returned to England in 1942 and taught at the University of Glasgow. In 
December, 1943, he joined his British colleagues in the U.S. Even at this 
time, Dr. Fuchs had divulged to the Russians everything he knew about the 

MED447 1-3 



process of isolating 23B U for weapon use, including America's plan to build a 
uranium separation plant at Oak Ridge. 

h. In July 1944, Dr. Fuchs met with Harry Gold for the first time in 
Brooklyn, New York. Dr. Fuchs was then working at Columbia University 
developing the gaseous diffusion system of separating fissionable uranium 
atoms from nonf iss i onab I e uranium atoms, and, as one of three visiting scien- 
tists, had complete access to all phases of the important work at the univer- 
sity. Harry Gold was presently working as a chemist at the Pennsylvania Sugar 
Company in Philadelphia. At this time, Dr. Fuchs passed on to Gold, who later 
passed it on to his Russian courier, all that was known about the extraction 
process to perhaps enable the Russians to construct an Oak Ridge of its own. 
This same year the Soviet purchasing commission was able to buy openly 1,300 
pounds of uranium oxide and uranium nitrate in this country. The following 
year, before the first bomb was tested, we gave Russia 25 pounds of low grade 
uranium metal and a quantity of heavy water. Also that year, the Germans 
constructed their first experimental "pile" for industrial use. 

i. In 1945, during the first week of the year, Dr. Fuchs spent a short 
holiday with his sister in Cambridge, Massachusetts, and was visited there by 
Harry Gold. With the six months that Dr. Fuchs worked at Los Alamos, he was 
now bursting with information, such as the name of the laboratory, the 
progress that had been made on the plutonium bomb, the principle of the 
implosion system and the implosion lens concept. Harry Gold arranged to meet 
Dr. Fuchs six months later in Santa Fe, New Mexico. In January, Sergeant 
Greenglass, while on furlough from Albuquerque, went to New York to visit his 
sister, Mrs. Anna Rosenberg, and while there wrote down everything he 
remembered about the explosive lens system for the implosion type weapon. In 
June, Dr. Fuchs drove his battered secondhand Buick over the Castillo Street 
Bridge on the outskirts of Santa Fe where he picked up Harry Gold for their 
prearranged meeting. From Santa Fe, Harry Gold traveled via a bus to 209 
North High Street in Albuquerque, New Mexico, where he met with Sergeant 
Greenglass who turned over to Gold additional drawings and specifications of 
the fantastically complicated trigger or initiator of the atomic bomb. It was 
the perfect complement to Dr. Fuchs* material on the best method of sepa- 
ration of 238 U from 23e U. For his trouble, Sergeant Greenglass received $500 
from Gold, and, being the patriotic American that he was, promptly bought a 
$50 war bond. Upon returning to the east coast in June, Harry Gold met with 
his Soviet contact Anatolei A. Yakovlev, the Soviet Vice Consul in New York, 
and turned over to him the two packets of information that he received from 
Dr. Fuchs and Sergeant Greenglass which included the implosive lens system, 
the initiator design, and the target date for the first full— scale test that 
would probably take place in July. 

j. Louis Slotin had been chosen to test the critical ity of the world's 
first atomic bomb; he was tickling the tail of the Trinity dragon with two 
silvery gray hemispheres of plutonium metal brought together by a screwdriver. 
At the beginning of July, there was not enough plutonium at Los Alamos to 
build the Trinity bomb. On the night of 15 July, David Hornig, the explosive 
expert who was responsible for the firing circuits of the implosion weapon, 
spent the night babysitting the bomb atop the 100— foot tower reading the book 
book entitled "Desert Island Decameron" and counting the f I ash— to— bang time of 

MED447 1-4 



the lightning bolts during a thunderstorm in an attempt to determine how close 
they had struck to the tower — considering all the while the possibility of 
their energizing the firing circuits. The first nuclear detonation occurred 
at 05:29:45, 16 July 1945. The temperature at its center was about 4 times 
that of the center of the sun and more than 10,000 times that of the sun's 
surface. The pressure caving down on the ground beneath the tower was over 
100,000 atmospheres — the most ever to occur at the earth's surface. The 
radioactivity emitted was equal to one million times that of the world's total 
rad ium suppl y . 

k. The reaction of the observing personnel is noteworthy. General 
Farrell turned despairingly to a fellow officer and said, "The long hairs have 
let it get away from them." Kistiakowsky cried deliriously, "I won the bet, I 
won the bet, Oppie you owe me $10." Dr. Oppenheimer, trembling, reached for 
his wallet, "It's empty, you have to wait," he said in utter seriousness; the 
two men embraced. Dr. Oppenheimer slowly dropped scraps of paper from his 
pocket and watched them as they were swept by the shock wave to determine the 
yield of the weapon which he calculated to be 20 KT . When Dr. Bush remarked 
that the light seemed to be brighter than any star, General Groves lapsed into 
one of his rare humorous moments and said, "Brighter than two stars," pointing 
to his major general's shoulder insignia. Later, Dr. Connant and Dr. Bush 
stood at attention while Dr. Oppenheimer, still shaking, allowed Dr. Rabbi to 
drive him into the hills to unwind; they stood at attention, their hats off, 
in salute to the men who built the atomic bomb. At that instant, all the 
Plutonium produced to date was used. On 23 July 1945, the scientists at Los 
Alamos completed production of sufficient amounts of plutonium for the 
implosion combat weapon. 

1-2. FIRST USE OF NUCLEAR WEAPONS 

a. On 26 July 1945, the ship, Indianapolis, reached Tinian and Major 
Firmin and Captain Norlan delivered their shipment of 23 °U to the waiting 
airmen of the 509th Composite Air Group for use in the gun assembly weapon to 
be used on Hiroshima. That evening the United States, Britain, and China 
issued to the Japanese the ultimatum that was to become known as the Potsdam 
Declaration. The document called for Japan to surrender unconditionally or 
suffer annihilation and it was signed by Truman, Churchill, and Chiang 
Kaishek. Russia, not yet at war with the Japanese, did not participate. Two 
days later, the Japanese premier rejected the ultimatum as out of hand and 
unworthy of public notice. 

b. Though General Marshall and general Eisenhower were deeply 
disturbed with the idea of a surprise nuclear attack on Japan and the fact 
that the United States would be the first nation to use such a weapon, the 
decision was made by President Harry Truman. The victim cities nominated for 
the atomic attack were Hiroshima, Kokura, Niigata and Kyoto. All were 
approved by Secretary of War Stimson, except Kyoto, the ancient capital and 
cultural mecca of Japan. In Kyoto's place, Nagasaki was picked. 

c. On 6 August 1945 at 0815 hours, the gun assembly type nuclear 
weapon (which had never actually been tested) was dropped on Hiroshima and 
detonated at 1,850 feet. The weapon was called "the little boy" or "the thin 

MED447 1-5 



man." This first atomic bomb, which was detonated on an enemy, had blown 
three-fifths of the city off the earth; 20 percent of the population was wiped 
out, 60 percent of the city was destroyed, 76,000 persons were injured, 13,000 
were missing, and 68,000 men, women, and children died in the attack. Captain 
William Parsons, who had armed the bomb en route to Hiroshima aboard the Enola 
Gay, forwarded his report to Washington, making a note mindful of his supply 
responsibility that "I certify that the above material was expended to the 
city of Hiroshima, Japan, at 0915, 6 August 1945." The Enola Gay returned to 
Tinian and landed without any gas. The Indianapol is was sunk by the Japanese 
four days after leaving Tinian. On 9 August 1945, at 1201 hours, a duplicate 
of the Trinity bomb rolled out of the belly of the silver fortress, called a 
"boxcar," from 29,000 feet on Nagasaki and devastated the city within a 
fraction of a second. This weapon was the implosion type and was called the 
"fat man" in honor of Winston Churchill. It had cost $25 million to produce 
and it killed nearly 40,000 Japanese. On 12 August 1945, a second plutonium 
"fat man" was ready for shipment to Tinian; however, at the last minute, 
General Groves fortuitously delayed the shipment for on 14 August 1945 the 
Japanese surrendered unconditionally. 

1-3. NUCLEAR WEAPONS AFTER JAPANESE SURRENDER 

a. On 21 August 1945, a fatality due to radiation occurred at Los 
Alamos when the dragon lashed back at young Harry Daghlian and sprayed him 
with a lethal dose of radiation. 

b. On 5 September 1945, Lieutenant Igor Couzenko, a cipher clerk in 
the Russian embassy in Ottowa, defected to the West taking with him many 
secret papers, some of which would later implicate Dr. Allen Nunn May, who 
gave information and small amounts of 23e u and 23B U to Karl Zabotin, who was 
the military attache of the Russian embassy. On 19 September 1945, Harry Gold 
and Dr. Fuchs had their last meeting at the door of a church on the outskirts 
of Santa Fe; there Dr. Fuchs described the violence of the test of the first A 
bomb at Trinity which he had witnessed with some of the most respected 
scientists in the world, including Fermi, Lawrence, Orr, Wagner, K ist iakowsk i , 
Oppenheimer, and others. In November 1945, intelligence agents during the 
advance of allied armies in Europe had recovered enemy documents indicating 
that Germany had been virtually out of the atomic bomb race from the start. 
Their progress was now where the United States had been in 1942. In December 
1945, Karl Zabotin (code name "Grant"), who was the military attache of the 
Russian embassy in Ottowa, escaped to Russia from a New York port following 
the defection of the cipher clerk, Igor Couzenko. In February 1946, Dr. May 
was found guilty and sentenced to ten years in prison at Wakefield in 
Brookshire, England. In a painstaking examination of Dr. May's voluminous 
notebooks which he had filled during his years of work in the A— bomb project, 
the lone word "Fuchs" was discovered. Also, during the same month, David 
Greenglass was honorably discharged from the Army. During his bomb work with 
the newly developed Sandia Weapon Laboratory in Albuquerque, he had risen to 
head foreman of the explosive shop and had been promoted to sergeant. The 
Army had given him a good conduct medal as a parting gesture. 

c. In May 1946, Louis Slotin became the second atomic scientist to die 
of a radiation accident when his screwdriver slipped on the plutonium 

MED447 1-6 



hemispheres and they started to lock together in a chain reaction. Slotin 
tore them apart with his bare hands and saved the lives of seven other 
scientists in the room. He himself absorbed 880 rad of radiation. It was one 
of the last jobs of Klaus Fuchs to report the physics aspects of what had 
happened in the fatal moment of the young scientist, who had determined the 
nuclear size of the first atomic bomb. 

d. The Atomic Development Authority of the United Nations proposed 
that once the disarmament plan was in effect, further manufacture of atomic 
bombs would halt and existing stockpiles would be dismantled. That a cruel 
joke was perpetrated on America by these atomic spies was evident a month 
later when the Soviet representative to the UN denounced the proposal. The 
Soviets had no need of it for in the reports of Dr. Fuchs and Sergeant 
Greenglass; they had enough information to start an atomic arsenal of their 
own. 

e. In November 1947, Dr. Fuchs returned briefly to the United States 
to take part in the Atomic Energy Commiss i ons' s so— called declassification 
conference. The British, on the suggestion of Scotland Yard, left him off the 
recommended list, but three renowned American scientists insisted that Fuchs 
be among the British physicists to attend. In September 1949, President 
Truman announced that the Russians had successfully tested their first A-bomb. 
Some authorities, such as General Groves, did not believe the Russians could 
effect this feat until the 1960's. 

f. In January 1950, Scotland Yard put the question as to his wartime 
spying directly to Fuchs, directed in part from the lone word of his name in 
Dr. May's notebook. At the time of his discovery, he was working in the 
Harwell Laboratory, where he had recently been promoted. Paradoxically, Dr. 
Fuchs would not divulge the information, which he had passed on to the 
Russians, to the Scotland Yard personnel because, in his estimation, it was 
highly restricted scientific data, and they were not cleared for such 
material. He did give a detailed report later to Dr. Michael Terrin. In 
March, Dr. Fuchs was sentenced to 15 years in prison. 

g. Harry Gold was now working on a heart research program at the 
Philadelphia General Hospital. A search was made at his home in Philadelphia 
on the morning of 22 May 1950, where in his bedroom they found a folded map of 
Santa Fe with an X mark at the Castillo Street Bridge where Harry Gold had met 
Dr. Fuchs in June 1945. This was the undoing of Gold for he had sworn to the 
agents that he had never been west of the Mississippi. Also that month, in 
spite of his brother-in-law, Julius Rosenberg, giving him $5,000 to escape to 
Czechoslovakia, David Greenglass stayed in his New York flat and was caught, 
turned state's evidence, and received a 15— year prison term. His wife, Ruth, 
was not tr ied . 

h. After their trial, which brought forth a verdict of death in the 

electric chair at Sing Sing, the Rosenbergs appealed their case, but lost 

their appeals and were required to pay the penalty prescribed by the court. 
Both were executed in Sing Sing Prison, New York, on 19 June 1950. 



MED447 1-7 



i. In 1958, Harry Truman said in retrospect that the conservative 
estimate for invasion of Japan was the lives of 750,000 Americans, 250,000 
kiiled and 500,000 maimed for life. He said "I did what I thought was right." 

j. In 1959, Klaus Fuchs was released from prison in England. Within 
days he boarded a Polish airliner and flew to East Germany, where he announced 
that he was a Marxist and intended to become an East German citizen. He later 
became the deputy director of the East German Central Institute for Nuclear 
Studies. Congress' Joint Committee on Atomic Energy stated that Dr. Fuchs 
alone influenced the safety of more people and accomplished greater damage to 
a nation's security than any other spy, not only in the history of the United 
States, but in the history of the nations. Dr. Fuchs helped build the 
Trinity, Hiroshima, and Nagasaki bombs and was familiar with advanced research 
and development in the field of atomic weapons, which were not to reach the 
testing stage until 1951, and the early studies of the hydrogen bomb. 

1-4. PRINCIPLES OF OPERATION OF A NUCLEAR DETONATION 

a. General. Nuclear engagement can run the gamut from employment of 
small, low yield, tactical weapons to strategic weapons of megaton yields. 
Regardless of the manner in which these weapons are utilized, survival and 
resumption of mission are possible for those who understand the hazards 
involved. In order to understand the principles which make nuclear weapons 
function, a general knowledge of the language of physics is necessary. 

b. Basic Terms. First, what is an element? An element is any sub- 
stance that cannot be separated into a simpler substance by ordinary chemical 
means. An atom is the smallest unit of an element which retains the physical 
and chemical characteristics of that element. Having these two terms in hand, 
the definition of the atomi c mass un i t (AMU) follows: abbreviated "AMU" the 
unit atomic mass is invaluable in nuclear physics as a unit of measure, due to 
the fact that the masses or "weights" with which one must deal in describing 
atoms are so small that other units of weight become unwieldy. The AMU is 
based on the common isotope of carbon 1 2 C . Using this isotope as a standard 
mass, one AMU is further defined as one— twelfth the mass of the standard 1 2 C 
atom. This gives a unit of measure which can describe atoms and subatomic 
part ic I es. 

c. The A— Z Number System. 238 U is an example of the A— Z number 
system. Its construction can best be shown by the formula A zX. In this 
formula, Z represents the number of protons found in the nucleus of the atom 
in question, or its atomic number. The X represents the chemical symbol of 
the element to which this atom belongs. The A represents the atomic mass 
number, that is, the total number of protons and neutrons, found in the 
nucleus. All uranium atoms have an atomic number, or Z number of 92. In 
fact, it is the number of protons in the nucleus that determines the element 
to which an atom belongs. Consequently, in 23e U, the A number is 238 or 
atomic mass number. It simply means that in this nucleus there are 238 
nucleons or 238 protons and neutrons. It is easy to see now, that by using 
this form of "shorthand," the composition of the atom can be identified. 



MED447 1-8 



23S 92U is an atom of uranium with 92 protons and 146 neutrons composing its 
nucleus. The number of neutrons is found by subtracting Z (protons) from A 
(tota I nuc leons) . 

d. Isotopes. Isotopes have been mentioned earlier, but what is an 
isotope? The term isotope means an atom of a specific element (same Z num- 
ber) that has a higher or lower mass than other atoms of the same element 
(different A number). Take hydrogen for example; common hydrogen, or protium, 
has a nucleus consisting of one proton. As defined, any atom with one proton, 
or Z number 1, is hydrogen. There occur in nature, two isotopes of hydrogen 
other than protium. First is deuterium which has a Z number of 1, but an A 
number of 2. The other isotope is tritium, with one proton and two neutrons 
in its nucleus. These three different atoms are all hydrogen, but deuterium 
and tritium are so— called "heavy hydrogen." 

e. Protons, Neutrons and Electrons. The proton, found in the nucleus 
and represented by the symbol 1 ip has a mass of approximately 1 AMU. It 
carries a positive charge of magnitude arbitrarily given the value of +1. The 
neutron, also found in the nucleus and represented by the symbol 1 on, also has 
a mass of approximately 1 AMU. As its name indicates, it is electrically 
neutral. The electron is found orbiting the nucleus, much as the planets 
orbit the sun. It is symbolized e— . The electron mass is about 1/1840 AMU, 
and yet it carries a negative electrical charge of the same magnitude as the 
proton or —1. These are the three basic building blocks from which all atoms 
are made. 

f. Nuclear Energy Release. Shortly after the turn of the century, Dr. 
Albert Einstein postulated that E = mc 2 . That is, that E (energy) is equal to 
m (mass) multiplied by c (the velocity of light) squared. Simply stated, Dr. 
Einstein said that mass could be converted to energy and energy to mass in 
accordance with his formula. The necessity for this formula is pointed up by 
a simple mathematical exercise in which the experimentally known masses for 
protons and neutrons are used to construct the experimental atomic mass of an 
atom. For example, the helium nucleus is composed of two protons and two 
neutrons. By multiplying the values for the masses of two protons and two 
neutrons, then adding, there results a hypothetical value of 4.03316 AMU for 
the helium nucleus. The experimentally obtained mass of the helium nucleus is 
only 4.00277 AMU. This discrepancy can only be explained by the use of the 
Einsteinian concept. What has happened is this: mass has been lost, or more 
accurately turned into energy. The energy is required to hold the nuclear 
components together. In this nucleus two positive charges are held in very 
close proximity, and the energy required to overcome the forces of repulsion 
is considerable. So, mass has been converted to the required energy, and 
consequently lost. This phenomenon is called "mass defect." In applying 
Einstein's formula to the conversion of 1 gram of mass, multiply 1 gram by (3 
X 10 1 ° cm/sec) 2 which is 9 X 10 20 gram cm 2 / sec 2 , or 9 X 10 20 ergs. The 
definition or "ergs" is relatively unimportant if it is realized that a 9 with 
20 zeros following it is an extremely large number. In fact, this energy 
release is approximately equal to the energy released by a 20 kiloton weapon, 
or the yield of the weapons detonated over Hiroshima and Nagasaki. The energy 
associated with a nuclear detonation comes from the product of the conversion 
of the many minute masses to energy in accordance with E = mc 2 . 

MED447 1-9 



g. Four Basic Types of Nuclear Reactions. The four basic types of 
nuclear reactions are scatter, capture, fission, and fusion. The scatter 
reaction is basically similar to the carom of billiard balls. In the example 
of neutron bombardment of hydrogen, a neutron acts like a cue ball against the 
target nucleus, a hydrogen atom. The neutron strikes the proton forming the 
hydrogen nucleus, and physically slams it away from its original position. 
This reaction is academically interesting, but not of any value for weaponry 
purposes. Another interesting reaction is capture of the incident particle. 
One example is neutron capture by cadmium 113. Upon capturing the neutron, 
the atomic mass of the atom is raised to 114, and a gamma ray is emitted. 
Interesting? Yes, but of no value in constructing weapons, but two of the 
four common reactions are valuable in weaponry. Fission was the basis for the 
first nuclear weapons, and it is still used extensively. In this reaction a 
neutron is utilized against a target nucleus of the heaviest elements. A 
neutron at the proper energy level will cause a fissioning or splitting of the 
heavy nucleus into two fission fragments of much lighter A number. Associated 
with this splitting are two extremely important by— products. The reaction 
releases a relatively great amount of energy and at the same time, free 
neutrons are released. These facts make possible the construction of a 
nuclear weapon. Energy is released from the reaction, and it produces the 
means of sustaining itself at the same time. The fusion reaction is also 
important because just what it says — a fusing or joining of nuclei. The 
lightest nuclei, those of hydrogen, are best suited for this purpose because 
the energy release from this reaction is greater than the energy put into it 
to cause it. Consequently, the fusion reaction is desirable for weapons 
systems . 

h. Materials Used to Obtain Nuclear Reactions. 

(1) There are two suitable and available fissionable materi- 
als — 238 U and 233 Pu. 238 U is a naturally occurring isotope of uranium, but it 
occurs as only one part in 140 of the native ore. Due to this fact, a means 
of extracting 238 U and purifying it is necessary. 238 U, although extremely 
expensive, is readily available. Plutonium is a manmade element. It does not 
occur in nature. Plutonium is produced by bombarding 23S U, which comprises 
more than 99 percent of the native ore, with neutrons. When the neutrons are 
captured, a series of transmutations takes place and the result is 23S Pu, an 
excellent fissionable material. Both of these materials are radioactive. 
That is, they emit particles and rays as they tend toward a stable state. 
This process is called "radioactive decay." The time frame for radioactive 
decay is called the "half— life." Half— life refers to the length of time 
required for a given amount of a radioactive substance to lose one— half of its 
radioactivity. For instance, 23e u has a half-life of 4.5 billion years, that 
of 238 U is 700 million years, 239 Pu is 24,000 years, and so on. Each 
radioactive isotope has its own characteristic half— life. Once a weapon with 
either uranium or plutonium is made, there is no need to worry about the 
fissionable material decaying to stability in a short time. 

(2) There are two fusible materials suitable for nuclear weap- 
ons — deuterium and tritium. Both of these hydrogen isotopes occur in nature. 
Deuterium comprises only about 0.02 percent of natural hydrogen. Tritium 
occurs only as an extremely rare trace; consequently, it must be artificially 

MED447 1-10 



produced to make it available for use in thermonuclear weapons. Only tritium 
is radioactive. Deuterium is a stable isotope. 

1-5. FISSION REACTIONS IN A NUCLEAR DETONATION 

a. Recall that fission is the splitting of a heavy nucleus to form two 
lighter nuclei, which release energy and two or three free neutrons. The 
weapon is basically constructed with three major components — first, a source 
of neutrons to begin the reaction; a supercritical mass of fissionable 
material to sustain a multiplying chain reaction; and finally, a casing in 
which to put this material so that it will hold together long enough to get a 
sufficient number of fission generations for a profitable energy release. 

b. The neutron source shoots a neutron, at the proper energy level, 
into the fissionable material; in this case 238 U. The uranium nucleus 
fissions, throwing off two fission fragments, releasing about 200 Mev of 
energy and freeing, on the average, 2.5 neutrons. These neutrons, if prop- 
erly handled, will each cause the same reaction that produced them, and the 
number of fissions soon builds to astronomical proportions. The fission gen- 
erations build in geometric progression — one causes two, two cause four, four 
cause eight, and so on. Each individual fission releases energy and neu- 
trons, with fission fragments as by— products. It is interesting to note that 
of some 200 different isotopes that may be produced as fission fragments, all 
are radioactive. 

c. Fissionable material is spoken of frequently in terms of what it 
will do. Generally speaking, a critical mass is the amount of material that 
will sustain a chain reaction with a steady output of energy. This is the 
principle used in nuclear reactors to produce a level energy release. A 
critical mass will not cause an explosion, nor will the chain reaction die 
out. A subcritical mass is an amount of material that will not sustain a 
chain reaction. Conversely, a supercritical mass is the amount of material 
necessary for a multiplying chain reaction, or explosion. 

d. There are a few more "wrinkles" associated with nuclear weapons 
that are of general interest. Recall that a 20— kiloton yield is the result of 
the conversion of about 1 gram of mass to energy. The amount of fissionable 
material required for a weapon is considerably more than 1 gram since systems 
are not 100 percent efficient. However, there are five methods available to 
increase the efficiency of fission systems. 

(1) First, purify the material to be used so as to obtain the most 
favorable ratio of fissionable nuclei possible. 

(2) Using this purified material, a subcritical mass can become 
supercritical, that is, physically pushing the nuclei closer together through 
compression. This can be accomplished through the use of a specially designed 
explosive charge. Forcing the nuclei closer together greatly increases the 
probability of hitting fissionable nuclei. 



MED447 1-11 



(3) To further increase the efficiency of this system, surround 
the fissionable material with some substance that will reflect neutrons, which 
would otherwise escape, back into the fissioning material. 

(4) By using a shape that will present the least amount of sur- 
face area per unit volume (a sphere), the number of neutrons escaping from the 
fissioning material can be reduced to a minimum. 

(5) Finally, by surrounding the fissionable material with a 
material that will slow or moderate the "speed" at which the neutrons are 
moving, will greatly increase the probability of fissioning. This is due to 
the fact that 238 U and a3a Pu are fissioned by thermal neutrons, that is, 
neutrons that are "moving very slowly." By employing one, or any combination 
of these methods, the cr i t i ca I i ty of the fissionable material can be 
appreciably increased. 

e. Numerous questions have arisen as to how fast the fissioning of a 
weapon occurs. This probably is due to the fact that the representations of 
fission reactions that are used somehow impress one with the feeling that the 
reactions take place at a rather leisurely pace. This is not the case. The 
average time required for a fission to occur is one shake. A shake is 1/100 
of a microsecond, or 1/100,000,000 of a second. It takes about 51 fission 
generations to produce a 1 KT yield. It takes only 7 additional generations 
to raise the yield to 100 KT. It is obvious, then, that to obtain a large 
yield, less than a mi I I ionth of a second passes from the time the reaction 
starts, until all of the energy is released. 

f. It is hard to imagine the meaning of "1 KT." An analogy that might 
help is that of TNT stacked on a football field. If the playing field in any 
football stadium is stacked with "bricks" of TNT on it, the stacks would have 
to be 9 feet high, and covering the entire field, to equal 1 kiloton, or 1,000 
tons of TNT. A megaton of TNT would be a stack 9,000 feet high. Twenty 
megatons of TNT would make a stack covering the entire playing field, over 34 
miles high! The explosive force of these weapons is truly unbelievable. The 
20 KT weapon, now called a "nominal" weapon and often forgotten or sneered at 
because of its puny yield, was sufficient to create an absolute hell out of 
two fairly large cities during World War II. 

1-6. FUSION REACTIONS IN A NUCLEAR DETONATION 

a. The reaction utilized in "thermonuclear" weapons is fusion rather 
than fission. Three components are needed for the weapon; a fission trigger, 
fusible material, and a case to put these in. Fusion is the joining of two 
light nuclei to form one heavier nucleus. This reaction will take place only 
in an environment of extreme heat and pressure. The only practical way to 
obtain this environment is through the use of fission. Today, the fission 
weapons used on Hiroshima and Nagasaki are suitable for triggers to start off 
the fusion reaction. First, the fission device is detonated, creating the 
essential environment. Next, the fusion process begins to take place. There 
are a number of fusion reactions which can occur. In a typical example, two 
nuclei of deuterium fuse, releasing energy and a free proton, and forming a 



MED447 1-12 



tritium nucleus. This nucleus, in turn, reacts with a deuterium nucleus to 
release energy, release a free neutron, and form a helium nucleus. The 
resultant energy releases of two reactions described above are 4.04 Mev and 
17.6 Mev, respectively. 

b. One other question has come up frequently. One fission releases 
about 200 Mev of energy. A tritium fusion (the most efficient with regard to 
energy release) releases only 17.6 Mev of energy. Why is it, then, that the 
"hydrogen bomb" is so much more powerful than a straight fission weapon? The 
answer is Avogadro's Number. This number represents the number of atoms in 1 
gram/atomic weight of a substance. Avogadro said that in 1 gram atomic weight 
there would be 6 X 10 23 atoms. The atomic weight of 23 °U is 235.1 AMU. 
Therefore, there are 6 X 10 23 atoms in 235.1 grams of 23B U. The atomic weight 
of tritium is 3.02 AMU. Therefore, in 3.02 grams of tritium there are 6 X 
10 23 atoms. Then, if there are 235.1 grams of tritium, instead of uranium, 
there will be about 78 times as many nuclei available for reaction. Since the 
nuclei react in pairs, there could be about 39 times as many reactions. This 
results in an energy release about 3.5 times greater with a given amount of 
tritium than the energy obtained from an equal mass of uranium. This is the 
reason for increased yield. 

1-7. SUMMATION 

Discussed above have been the basic components of atoms — the proton, 
neutron, and electron. The fission and fusion processes were discussed and 
contrasted as being highly energetic processes in one of which nuclei of a 
heavy element are split into two lighter nuclei while the other is a joining 
of two light nuclei to form a heavier one. Also discussed were the time rates 
of the processes, their comparative energy emission and the k i I oton/megaton 
concepts of energy yield. Lack of the basic knowledge makes understanding of 
nuclear warfare impossible and understanding means survival! 



Section II. NUCLEAR BLAST 



1-8. NUCLEAR WEAPON CASUALTIES 

a. Mass Casualties. The effects of a nuclear detonation generate 
damage to an extent unknown in the annals of military weaponry. Since it is 
the business of the AMEDD personnel to care for the injured, and considering 
the high casualty potential of nuclear weapons, it would appear that members 
of the Army Medical Department would be remiss in their responsibility if they 
did not, first of all, recognize the possibility of nuclear war — to assume 
otherwise is totally unrealistic and an invitation to disaster; second to 
understand the effects of these weapons; and third, to know what can be done 
to minimize casualties and maximize survival. From the medical point of view, 
if there were a nuclear war, the medical community would face an almost 
impossible task, even if by some miracle all facilities, equipment and per— 



MED447 1-13 



sonnel survived. One needs only to view the medical resources in Hiroshima 
before and after the nuclear attack (shown below) to conclude that injuries 
from a nuclear explosion must be avoided, prevented, or at least minimized. 



Phys i c i ans 
Nurses 



Before After 
298 " 28 

1,780 126 



b. Energy Release — Nuclear Versus Conventional. An explosion, in 
general, results from the very rapid release of a large amount of energy 
within a limited space. This is true for a conventional "high explosive" such 
as TNT, as well as for a nuclear explosion, although the energy is produced in 
quite different ways. There are several basic differences between" nuclear and 
h i gh— expl os i ve weapons. In the first place, nuclear explosions can be many 
thousands or millions of times more powerful than the largest conventional 
detonations. Second, a fairly large proportion of the energy in a nuclear 
explosion is emitted in the form of light and heat, generally referred to as 
"thermal radiation." Third, the nuclear explosion is accompanied by highly 
penetrating and harmful rays, called the "initial nuclear radiation." 
Finally, the substances remaining after a nuclear explosion are radioactive, 
emitting similar radiations over an extended period of time. This is known as 
the 'residual nuclear radiation." 

1-9. NUCLEAR WEAPONS DETONATIONS 



Nuclear Energy Distribution, 



(1) The 
rated in terms of t 
would release the s 
to several thousand 
(KT) of TNT. Thus, 
of TNT; the energy 
each of the two wea 
development of hydr 
i n the order of mil 
stated in megatons 
k i I otons. To unders 
at a few comparativ 



release of energy in 
he quantity of conven 
ame energy. The earl 
tons of TNT. A thou 
weapons are rated as 
released is cal I ed th 
pons dropped on Japan 
ogen bombs has meant 
I ions of tons of TNT. 
(MT) of TNT equivalen 
tand what kind of wea 
e figures: 



an explosion of a nuclear weapon is 
tional high explosives (TNT) which 
y weapons released energy equivalent 
sand tons of TNT is called a kiloton 

having the equivalent of so many KT 
e yield of the weapon. For example, 

had a yield of about 20 KT. The 
that weapons may have energy release 

The yields of such weapons are 
t. One megaton is equal to 1,000 
pons these are, it may be well to look 



(a) Energy equivalent of one Hiroshima or Nagasaki type 
bomb — 20,000 tons of TNT. 

(b) Energy released by conventional bombs dropped on Berlin 
during all of World War II — 35,000 tons of TNT. 

(c) Energy equivalent of a 1— MT bomb — 1 million tons of TNT 



MED447 



1-14 



(2) The energy released by conventional bombs dropped by the 
Allies upon Japan and Germany and the occupied countries of Europe during 
World War II was 5 million tons of TNT (approximately). 

(3) It is possible to construct one bomb whose yield would be 
greater than all of the high explosives ever detonated for any reason since 
the beginning of human history. The limit on weapon yield is no longer one of 
construction — it is, rather, one of practical usability. For strategic 
targets, large yields are desirable. For tactical application, on the battle 
field of the future, weapons ranging in yield from 1 KT or less up to several 
times the yields of those dropped upon Japan will be desirable. It is 
doubtful that any field commander will need or want the largest yields. 

(4) The transfer of energy from the nuclear weapon to the sur- 
rounding media begins immediately and is exhibited in three distinct casualty 
producing effects (fig. 1—1). Although the distribution of energy varies 
somewhat depending on the weapon and condition of the explosion, it is gener- 
ally about as follows: 

(a) Fifty percent as blast and shock: As the altitude 
increases, the percentage of the total energy appearing as blast is reduced 
due to the low air density. 

(b) Thirty— five percent as thermal radiation: As the alti- 
tude is increased, the percentage of the total energy appearing as thermal 
radiation is increased, since less thermal radiation is absorbed by the 
intervening air. It has been estimated that at great heights, where the 
density of the air is extremely low, more than 50 percent of the fission 
energy might appear as thermal radiation at some distance from the exploding 
weapon. 

(c) Fifteen percent as nuclear radiation (initial, 5 per- 
cent; residual, 10 percent). 

(5) Initial radiation is defined as those forms of radiations 
emitted from the fireball and nuclear cloud within the first minute after 
detonation. Those radiations emitted after the first minute are referred to 
as residual radiation and are usually associated with neutron induced activity 
and fallout. The 1— minute cutoff time is an arbitrary figure based on the 
fact that the fireball and nuclear cloud rise so fast that after 1 minute the 
radiations emitted cannot reach the ground in amounts that are considered 

mi I i tar i I y s ign i f icant . 

b. Types of Burst. Nuclear weapons may be burst at any point from 
deep below the surface to very high in the air. Tactically, nuclear bursts 
are classified according to the manner in which they are employed. 

(1) Subsurface burst. A subsurface burst is an explosion with its 
center beneath the surface of land or water. This type of burst is used to 
cause damage to underground targets and structures and to cause crater ing. 



MED447 1-15 



(2) Impact or contact surface burst. An impact or contact sur- 
face burst is an explosion at the surface of land or water, or at a height 
above the surface less than the maximum fireball radius. This type of burst 
will cause fallout and crater ing, and may damage hard underground targets 

located relatively near the surface of the earth. 

(3) A i r bursts. An airburst is an explosion in the air, above land 
or water, at a height greater than the maximum radius of the fireball. 



INITIAL 
NUCLEAR 
RADIATION 5% 



RESIDUAL 
NUCLEAR 
RADIATION 10%. 




BLAST AND SHOCK 50% 



MED447 



Figure 1-1. Distribution of energy 
1-16 



1-10. BLAST PHENOMENA 

a. In discussing the effects of a nuclear detonation, the terms 
"ground zero" and "radius of damage" are often used. Ground zero is the point 
on the ground directly under, at, or above the burst. Horizontal distances 
along the ground to which various effects extend are measured from ground 
zero. Every nuclear burst produces a radius of damage for each associated 
target element and degree of damage. For example, a weapon will have one 
radius of damage for moderate damage to wheeled vehicles, another radius of 
damage for severe damage to wheeled vehicles, and another for casualties to 
protected personnel. It is clear that in the employment of nuclear weapons, 
levels of damage must be understood and the three standard levels of damage 
must be defined in as precise a manner as possible. 

(1) The first level is I i ght damage . Light damage is that degree 
of damage which does not preclude the immediate use of the item in its primary 
mission. A good example of this would be a vehicle. Suppose that the 
windshield, tarp, and hood of a truck were blown off by the blast effect. 
While the truck has sustained damage, it can be driven without requiring any 
repairs. This, then, is light damage. 

(2) The second level is called moderate damage . This is defined 
as that degree of damage requiring extensive repairs before it can be used for 
the purpose for which it was intended. 

(3) The highest level is severe damage . This is defined as that 
damage which makes replacement more feasible than repair. 

(4) Personnel casualties, unlike material damage, are not 
classified as to degree. Whenever personnel cannot perform their duties and 
reguire medical attention, they are considered to be noneffective, or cas- 
ualties. 

b. When a nuclear weapon is detonated in the air, there is formed an 
intensely hot, luminous sphere of gases, called the fireball. Initially, the 
fireball expands so rapidly that a layer of highly compressed air is formed on 
the surface of the fireball. The atmosphere cannot get out of the way and 
piles up on the surface forming a shock front or blast wave. As the fireball 
cools and its rate of expansion slows down, the blast wave breaks away from 
the fireball and moves out in all directions at a very high rate of speed. As 
it loses energy, it loses speed until it reaches the speed of sound (1000 
ft/sec) and continues thereafter to move at that rate. As long as there is 
nothing in its way, -it will travel out in all directions; however, when that 
portion of the blast wave traveling downward from an airburst strikes the sur- 
face of the earth, it will be reflected or "bounced back." There will not 
only be the primary or incident blast wave, but there will also be a reflected 
blast wave. Since the reflected wave is traveling through heated air, it 
travels faster than the primary blast wave and somewhere on the ground, 
depending on the height of burst and energy of the explosion, it overtakes the 
primary blast wave and reinforces it to produce a much stronger pressure 
front. This merging of the reflected and primary blast wave is called the 
"Mach effect." The fused blast waves, which have a much greater damaging 

MED447 1-17 



effect than either the primary or reflected wave, are referred to as the "Mach 
stem." It is to be noted that there is essentially only one blast wave from a 
surface or subsurface burst; hence, the Mach effect is a distinguishing 
feature of the airburst. 

c. As the blast wave moves outward, it exerts two types of damaging 
pressures on all material in its path. While their separate intensities and 
effects can be measured, it is important to keep in mind that they always 
occur together. 

(1) The first pressure is static overpressure . (The maximum value 
at the blast wave front is called the peak overpressure). As the name 
implies, it has nothing to do with motion. This is a squeezing or crushing 
force which surrounds the object and continues to apply pressure from all 
sides until the pressure returns to normal. Targets, such as buildings, which 
are sensitive to and are damaged primarily by static overpressure, are called 
diffraction targets. The strength of the blast wave is measured in pounds per 
square inch (psi) above atmospheric pressure; i.e., 14.7 ps i at standard sea 
level conditions. 

(2) The second pressure is called dynamic pressure , and as the 
name implies, there is motion. As the blast wave moves away from the burst 
point, it is accompanied by high winds. Dynamic pressure is a measure of the 
forces associated with these winds. This pressure causes damage by pushing, 
tumbling, or tearing apart a target element. Targets, such as trucks, tanks, 
and most military equipment, which are damaged primarily by dynamic pressure, 
are called drag— type targets. While the two types of pressures are considered 
separately, they always occur together. Some indication of the relationship 
between static overpressure and maximum wind velocities for sea level 
conditions is shown below: 

5 ps i — 1 60 mi /hr 

10 psi — 290 mi/hr 

30 psi — 670 mi /hr 

(3) As a frame of reference as well as an important aspect of 
protection from airblast, the relationship between peak overpressure (psi), 
expected physical damage, and approximate range for a 20-KT and 20-MT air- 
burst weapon is below: 



MED447 1-18 









Approx imate 








Range in M i 1 es 


Mater ial 


ps i 


Damage 


20 KT 20 MT 


Glass windows 


.5-1 


Shatter i ng 


3.6 


36 


Wood frame buildings 










residential type 


2-3 


Moderate 


1 .9 


19 




3-4 


Severe 


,.5 


15 


Brick apartment house 


3-4 


Moderate 


1 .5 


15 




5-6 


Severe 


1 . 1 


1 1 


Mu 1 1 istory , stee 1 










frame, office building 


6-7 


Moderate 


1 


10 




8-11 


Severe 


.75 


7.5 


Motor vehicles 


9-13 


Moderate 


.7 


7 




13-20 


Severe 


.5 


5 



Table 1—1. Comparison of effects of ps i . 

(4) It is of interest to examine what happens when a blast wave 
moves past a structure, since the general interactions of a human body with a 
blast wave are similar. Suppose that on the roof of the building there was a 
pressure gauge which was instantly responsive to any change in pressure and a 
20— KT weapon was detonated in the air about 2 miles away. For a short 
interval after the detonation, there would be no change on the pressure gauge, 
since it takes the blast wave about 8 seconds to travel the distance from the 
point of detonation to the building (about 2 miles). When the blast wave 
arrives, the pressure on the gauge will suddenly increase sharply. At this 
time the blast wave will bend around the structure, engulf the building, and 
tend to crush it. Simultaneously, a great rush of air or strong winds will 
strike the building and tend to push it, tear it apart, and hurl debris 
through the air. The blast wave acts on the building during its passage of 
the positive or compression phase for about 1.2 seconds. It is during this 
interval that most of the destructive action of the blast wave will be exper— 
enced. As the blast wave passes the building, the pressure begins to fall 
off, returns to normal, and then sinks below that of the surrounding atmos- 
phere. For most of the period when the pressure is below atmospheric pres- 
sure, the transient winds reverse direction and blow back towards the point of 
detonation. This is described as the negative or suction phase of the blast 
wave. There may be some destruction during the negative or suction phase, but 
less than in the positive phase. As the negative phase passes, the pressure 
returns to that of the normal atmosphere. The blast wind has then effectively 
ceased and the destructive action of the airblast is over. 



MED447 



1-19 



(5) Another important feature of the blast wave is its duration. 
When the blast wave with a high peak overpressure hits an object, it surrounds 
the object and continues to apply pressure from all sides in decreasing 
strength until the pressure in that vicinity returns to normal atmospheric 
pressure. This is how static peak overpressures produce damage. The longer 
an object is subjected to the squeeze of static peak overpressure, the more 
the damage which can normally be expected. 

(6) As the positive phase travels away from the burst, the peak 
overpressure decreases, but at the same time, the length of the positive phase 
increases both in time and in actual distance. For example, when the blast 

wave is .3 mile from a typical 1— KT airburst, the peak static overpressure is 
7.5 ps i and the duration of the positive phase is .28 seconds; while at .6 
mile, the peak static overpressure is only 2.4 ps i , but the duration of the 
positive phase is .38 second. 

(7) The duration of the blast wave is important because for some 
types of targets, such as tanks or trucks, a long, steady push of lesser 
strength will do as much or more damage than an instantaneous shock of greater 
strength . 

1-11. MODIFYING INFLUENCES ON AIRBLAST PHENOMENA 

a. Weather. Rain and fog cause attenuation of the blast wave because 
energy is dissipated in evaporating the moisture in the atmosphere. 

b. Surface Conditions. The reflecting quality of the surface over 
which a weapon is burst can significantly influence the distances to which 
blast effects extend. Generally, reflecting surfaces such as ice, snow, and 
water increase the distance to which static overpressure extends. Generally, 
they decrease the distance to which dynamic pressures extend. 

c. Topography. Most data concerning blast effects are based on flat 
or gently rolling terrain. There is no field method of calculating changes in 
blast pressures due to hilly or mountainous terrain. In general, static 
overpressures are greater on the forward slopes of steep hills and diminish on 
reverse slopes when compared with pressures at the same distance on flat 
terrain. Blast shielding is not dependent upon line of sight considerations 
because blast waves easily bend around apparent obstacles. The influence of 
small hills or folds in the ground is considered to be negligible. Hills may 
decrease dynamic pressures and offer some local protection from flying debris. 

d. Cities or Bu i I t— Up Areas. These areas are not expected to have a 
significant effect on the blast wave. Structures may provide some local 
shielding from flying debris. Some local pressure increases may result from 
structures channeling the blast wave. However, the general airblast charac- 
teristics in cities and urban areas are considered to be essentially the same 
as those for open terrain. 

e. Forests. Forests will not have a significant effect on blast wave 
characteristics, which are essentially the same as for open terrain. 



MED447 1-20 



f. Height of Burst. The height of burst determines the extent to 
which the blast wave is reflected and influences the strength of incident and 
reflected blast waves. 

1-12. DIRECT BLAST INJURY 

a. General. The phenomenon of blast interacts biologically with 
people to cause injuries. It should be pointed out, first, that among the 
injured that survived the explosions over Hiroshima and Nagasaki (over 70,000 
in Hiroshima and 21,000 in Nagasaki), approximately 70 percent experienced 
some type of blast injury — fractures, lacerations, contusions, or abrasions. 
For ease of understanding, the effects of airblast on personnel are referred 
to as either direct or indirect. Direct blast injuries are caused by the 
variations in environmental pressure accompanying a blast wave — that is, the 
fast— rising overpressures of long duration. Due to the body being rapidly 
engulfed by the blast wave and subjected to compression, decompression, and 
transmission of pressure waves through the organism, damage occurs mainly at 
junctions between tissues and a ir— conta in i ng organs and at areas of union 
between tissues of different density, such as cartilage and bone joint soft 
tissue. The chief consequences are ruptured eardrums, hemorrhage, and 
occasional rupture of abdominal and thoracic organs. The lungs are 
particularly prone to hemorrhage and edema (liquid extrusion) and if the 
injury is severe, air reaches the veins of the lungs, and hence the heart and 
arterial circulation. Death may occur in a few minutes from air embo I ic 
obstruction of the vessels of the heart or brain, but may also ensue from 
suffocation caused by hemorrhage or edema in the lung tissues. 

b. Probability of Fatalities. 

(1) Based on laboratory and field studies with animals, the esti- 
mated peak overpressures required for men to produce various probabilities of 
fatality are given below: 



Probability of Fatality 
(percent) 


Peak Overpressure 
(ps i ) 


1 
50 
99 


30-50 
50-75 
75-115 



(2) Damage to the lung can occur at overpressures as low as 15 
pounds per square inch, which may develop from reflection of an incident peak 
overpressure of 6 or 7 pounds per square inch. 

(3) Rupture of the normal eardrum is apparently a function of the 
age of the individual as well as of the rate of rise and fall, duration, and 
height of the peak overpressure. Failures have been recorded at overpressures 
as low as 5 ps i , ranging up to 40 or 45 ps i . The best value of the 
overpressure for 50 percent probability of eardrum rupture appears to be 
between 20 and 30 ps i . Ruptured eardrums alone usually will not produce 



MED447 



1-21 



ineffectiveness, although some people suffer pain, dizziness, and some degree 
of hearing loss. Sinus hemorrhage and bleeding from the nose is common in 
animals exposed to blast, but no reliable quantitative information is avail- 
able. Fracture of the thin orbital bones into the adjacent sinus cavities has 
been observed, but the appropriate values for man are not known. 



(4) The geomet 
may have a large effect on 
individual in the open or 
result of reflection. The 
pressure, may then be more 
Depending upon the dimensi 
overpressure inside a stru 
the incident pressure. Th 
rise and the duration of t 
individual inside a struct 
pressure, but, in addition 
location against a wall fa 
as regards direct blast ef 
reflection is then maximal 



ry" in wh ich a pers 
his response. Whe 
i n a I ong ha I I way o 
reflected pressure 
than double the in 
ons of entryway ope 
cture may be much I 
ere may a I so be alt 
he positive phase, 
ure wou I d not on I y 
, to ref I ect i ons of 
c i ng the bl ast wave 
fects, because the 



on is exposed 

n the pressure 

r tunne I , much 

, and hence th 

cident or open 

nings and inte 

ess, equal to, 

erations in th 

Under certain 

be exposed to 

the blast wav 

is the most h 

overpressure f 



to the blast wave 
wave reaches an 
of it may be as a 
e effective 

terrain pressure, 
rnal volume, the 
or greater than 
e rate of pressure 
circumstances, an 
the initial over— 
e from the wa I Is. A 
azardous position 
rom the initial 



(NOTE: The word "geometry" is used here to be a composite term to describe 
the location of an individual in relation to the details of his environment 
that may affect the blast wave characteristics.) 

(5) The predicted maximal ranges inside which direct blast 
injuries may be expected for various yield airbursts are shown below: 



1 njury 


Range in Mi les 


20 KT 


100 KT 


20 MT 


Eardrum failure threshold 
(No pressure reflection) 
5 psi 


1 .2 


2 


12 


Lung damage threshold 
(No pressure reflection) 
15 ps i 


.58 


1 


5.8 


Lethality near 50 percent 
(No pressure reflection) 
50 psi 


.27 


.48 


2.8 



(6) From the nuclear bombings of Japan, the direct blast effect 
was not specifically recognized as a cause of fatality, though it no doubt 
contributed significantly to early mortality even though most of the lethally 
injured individuals may also have received mortal injury from debris, dis- 
placement, fire, and thermal and nuclear radiation. Further, the high mor- 
tality among those with significant direct blast injuries can be explained by 
the overwhelming disruptive effects of the Japanese bombings on medical and 



MED447 



1-22 



rescue services. For these reasons, primary blast effects, except for eardrum 
rupture, were not commonly seen among Japanese survivors. 

(7) Although direct blast injuries are extremely hazardous and 
represent a type of injury to be avoided, it is doubtful that they will 
present a serious problem to the medical service in any nuclear conflict. If 
one is in the area where overpressures are sufficient to produce severe direct 
blast injuries, he may be simultaneously lethal ly burned and irradiated. For 
a 1-MT air-burst, for example, 50 ps i (near 50 percent lethality) is 
experienced about one mile from ground zero. At this location the thermal 
energy would be measured in hundreds of calories (about 800 cal/cm 2 ) and the 
nuclear radiation in the thousands of rads (about 15,000 rad) . At the 
distance where lung damage may occur (15 ps i range), about 200 cal/cm 2 and 20 
rad are experienced. A possible exception to this is the case of people in an 
inadequately designed shelter which provided good shielding from thermal and 
nuclear radiation, but which permitted entry of the blast wave or actually 
caused reinforcement or amplification of the airblast that entered. The 
important point is that not many direct blast injuries will be seen from the 
detonation of a nuclear weapon. 

1-13. INDIRECT BLAST INJURY 

Indirect blast injuries consist of fractures, concussions, lacera- 
tions, abrasions, and puncture wounds of body organs and cavities — resulting 
from the collapse of buildings, missiles flying through the air, and the 
physical displacement of man by the blast winds. 

a . F I y i ng M i ss i I es . 

(1) The physical and biological factors that determine the seri- 
ousness of injury from penetrating or nonpenetrating objects striking an 
individual are many, and as a consequence, the hazard to man is not quite so 
clear as is the case with damage from direct overpressure. In fixing the 
hazard to man from flying or falling objects, one must consider missile 
velocity, mass, size, and shape, along with the specific areas of the body 
involved. Ignoring most of these and for the sake of brevity, the missile 
prob I em wi I I be I imi ted and s imp I i f i ed here by us i ng on I y impact ve I oc i ty and 
missile mass to illustrate the conditions for skin lacerations, penetration 

into the abdominal cavity, fracture of feet and legs, and closed fracture of 
the sku I I . 

(2) Velocity criteria for the production of skin lacerations by 
penetrating missiles, such as glass fragments, are not known with certainty. 
It has been estimated, however, the threshold for skin lacerations from a 10- 
gram glass fragment appears to be about 50 feet per second in 10 feet of 
travel. The constraint of 10 feet of travel was arbitrarily placed upon a 
distance of travel because this was thought to be applicable to the average 
house. Concerning the probability of penetration of the abdominal cavity by 
glass, some reliable information is available based on the results of field 
work and laboratory studies. The impact velocities arbitrarily fixed in 10 
feet of travel for glass fragments of different masses, corresponding to 1, 
50, and 99 percent probability, are shown below. These figures represent 

MED447 1-23 



impact velocities with unclothed biological targets. Protective effects of 
clothing for low velocity debris are not well understood. 



PROBABILITIES OF GLASS FRAGMENTS PENETRATING ABDOMINAL CAVITY 



Mass of glass 
Fragments (grams) 



Probability of Penetration (percent) 
1 50 99 



0.1 

0.5 

1 .0 

10.0 



Impact Velocity (ft/sec) 



235 
160 
140 
115 



410 


730 


275 


485 


245 


430 


180 


355 



(NOTE: It should be noted that any wound involving a cavity is almost always 
accompanied by serious infections, even if a nearby organ escapes critical 
injury. The threshold for such injury can be taken to be about 100 feet per 
second for a 10— gram glass missile. For smaller fragments, the threshold 
velocity is higher. It is unfortunate that similar kinds of data for sharp, 
frangible objects are not available for the eye.) 

(3) The predicted maximal ranges with overpressures and wind 
velocities inside which a 10— gram glass fragment will attain sufficient impact 
velocity for a 5—0 percent probability (180 ft/sec) of penetration of the 
abdominal cavity for various yield airbursts are shown below: 





RANGE 


OVERPRESSURE WIND VELOCITY 


YIELD 


(mi les) 


(ps i ) 


(MPH) 


20 KT 


1 .3 


4.4 


140 


100 KT 


2.2 


4.3 


138 


20 MT 


15.0 


3.6 


115 



(4) With regard to nonpenetrating missiles, the head appears to be 
the critical organ, with the possible exception of impact over the spleen and 
liver. Little is known, however, concerning the physical requirements for 
injury from impact with the body wall near the spleen and liver; severe 
hemorrhage and death from rupture of these organs is not uncommon after 
accidents. With regard to head injury, a hard missile with a mass of 10 
pounds striking the head at a velocity of 10 ft/sec (7 MPH) appears to be a 
"safe" impact velocity; 15 ft/sec (11 MPH) appears to be the threshold for 
both cerebral concussion and skull fracture. At velocities of 23 ft/sec or 
above (16 MPH), skull fracture can be expected nearly 100 percent of the time. 



MED447 



1-24 



b. Falling Objects. It is interesting to note that a 10— pound object 
dropped from a height of 6 feet attains an impact velocity of about 19 ft/sec, 
with a probability of skull fracture about 50 percent. It is apparent that an 
object this size does not have to travel very far or very fast to cause 
serious injury to man. 

c. Translat ional Injuries. With respect to the problem of physical 
displacement of man from b I ast— produced winds, it is likely that most injuries 
will occur during decelerative impact with some hard object. Since a hard 
surface will cause more serious injury than a soft one, the damage criteria 
given below, based on various data, including auto accidents, refer to impact 
of the displaced body with a hard, flat surface. Translation velocities were 
computed at displacement distances of 10 feet. Fractures of the hee I , feet , and 
lower extremities can be expected at impact velocities of 11 to 16 ft/sec for 
hard surfaces with knees locked. The predicted maximal ranges inside which 
indirect blast injuries may be expected for various yield airbursts are shown 
to give a general feel for the problem and clearly indicate that blast hazards 
must be regarded as a major cause of injury and death. 

Mostly "safe" 10 ft /sec 

Skull fracture threshold 13 ft/sec 

Sku I I fracture near 50 percent 18 ft/sec 

Lethality threshold (whole body) 20 ft/sec 

Sku I I fracture near 100 percent 23 ft/sec 

Lethality near 50 percent (whole body) 26 ft/sec 

Lethal i ty near 100 percent (whole body) 30 ft/sec 



INJURY 



RANGE IN MILES 
20 KT 100 KT 20 MT 



Penetrating Missiles — 10 Gram 
Glass Fragment 

1. Skin laceration threshold (50 ft/sec) 

2. Serious-wound threshold (100 ft/sec) 

3. Serious wounds near 50 '/• (180 ft/sec) 

4. Serious wounds near 100 '/. (300 ft/sec) 



3 


5 


34 


1 .9 


3.4 


22 


1 .3 


2.2 


15 


.9 


1 .6 


1 1 



Physical Displacement of Man 
with Impact with Hard Surface 

1. Mostly "safe" (10 ft/sec) 

2. Skull fracture threshold (13 ft/sec) 

3. Fracture feet and legs (14 ft/sec) 

4. Skull fracture near 50 '/. (18 ft/sec) 

5. Lethality threshold (whole body) (20 ft/sec) 

6. Skull fracture near 100 '/. (23 ft/sec) 

7. Lethality near 50 '/. (whole body) (26 ft/sec) 

8. Lethality near 100 '/. (whole body) (30 ft/sec) 



5 


2.8 


23 


3 


2.4 


20 


2 


2.3 


19 


1 


2.1 


18 




1 .9 


17 


95 


1 . 1 


15 


9 


1 .7 


14 


82 


1 .5 


13 



MED447 



1-25 



1-14. PROTECTIVE MEASURES 

a. The phenomenon and the destructive effects of blast have been des- 
cribed along with the best available assessment of these effects on man. 
Since blast may be a major cause of injury or death and recognizing the almost 
impossible task facing the medical service, it is hard to escape one 
significant conclusion; namely, that injuries from blast may be at least 
minimized. This is not as difficult as most believe it to be. To illustrate 
this point, the survival data from Hiroshima below shows the percent survival 
as a function of range from ground zero under different conditions of expo- 
sure. Three groups of individuals are shown: (1) On the far right, school 
personnel in working parties, who were mostly in the open at the time of the 
detonation. (2) The curve in the central area applies to school personnel 
mostly inside schools when the explosion occurred. (3) On the far left is 
the survival curve for over 3,000 individuals located inside concrete build- 
ings at burst time. Survival here applies to individuals known to be alive 20 
days postshot. 




1.0 1.5 

RANGE. MILES 



b. There are a number of simple lessons portrayed by these survival 
curves which actually relate human experience with a nuclear detonation. 

(1) First, the 50 percent survival ranges for the three curves 
from the right to left of 1.3, 0.45, and 0.12 miles forcefully emphasized the 
importance of the conditions of exposure. 



MED447 



1-26 



(2) The area of complete destruction at Hiroshima has been 
described as covering a circle of about 1.2 miles radius (4 square miles), a 
range at which 4—5 ps i existed. At this range there was an overall survival 
of near 90 percent. It is apparent, therefore, that one must not confuse the 
area of complete destruction of houses (a physical concept) with "complete 
destruction" of people. Even in to near 0.2 miles, there was 5 percent 
overa I I surv i va I . 

(3) The great, good fortune of just being indoors and shielded 
against the most far— reaching effect, direct thermal radiation, is illustrated 
by the 50 percent survival range of 0.45 mile for school personnel, mostly 
inside, compared with 1.3 miles for those mostly outside. This proved so even 
though the fact of being inside involved exposure to falling and flying debris 
and higher pressure reflections. Apparently the latter hazards are relatively 
less than the dangers from direct thermal radiation. 

(4) The marked value of simply being inside concrete buildings is 
illustrated by the 50 percent survival range of 0.12 mile. This is most sig- 
nificant. There were 400 individuals inside the forward building, the post 
office. Two hundred became casualties almost immediately, no doubt mostly 
because of blast effects. The remaining 200 were alive 20 days later. Though 
many, no doubt, subsequently succumbed because of exposure to ionizing 
radiation, the effective shielding against thermal radiation, blast pressures, 
winds, and debris is quite clear. There was nothing special about the 
building except it was built to seismic codes. 

(5) The illustrated progressive decrease of the range for 50 per- 
cent survival from 1.3 miles to 0.12 miles — about a factor of 10 — as it varied 
with conditions of exposure occurred by accident in Hiroshima. These facts 
bring out clearly the greatly improved chances of survival from a nuclear 
explosion that could result from the pi anned adoption of suitable warning and 
protective measures. 

c. The problem of providing complete protection from blast is virtu- 
ally impossible; however, there is much that can be done to reduce materially 
the number of casualties. On the battlefield, trenches, foxholes, and bunkers 
offer considerable protection. It takes about 15 ps i to collapse these field 
for t i f i cat i ons . 

d. In cities, where a b I ast— res i stant shelter is not available, pro- 
tection should be sought in the strongest building that is accessible. Pro- 
tection against flying debris can be obtained by taking refuge in a location, 
preferably selected in advance, that is least likely to be entered by blast 
debris. In addition, individuals should stay away from w i ndows and eas i I y 
breakable materials, such as plaster walls or ceilings. In the collapse of 
buildings as a result of blast, heavy members and pieces of structural 
materials and contents will fall or be hurled about. There is a dual hazard 
of being hit and trapped; therefore, positions next to walls in basements 
offer the best protection. Above ground, however, the safest locations are 
generally near, but not against, walls and away from doors and windows. Even 
if there is no prior warning of a nuclear attack and the first indication is 
the flash of light, there may still be the opportunity to take some protec— 

MED447 1-27 



tive action against the effects of blast. Some approximate values of the 
times which elapse between the instant of the explosion and the arrival time 
of the blast wave front at various distances from ground zero for airbursts of 
various energy yields are given below. In distances at which the peak 
overpressure is 1 ps i or less, the times are not included. 



DISTANCE 








(Mi les) 


10 KT 


100 KT 


10 MT 


1 


(T ime in Seconds) 


3.7 




3.3 


1 .5 


I. 


8. 1 




7.4 


5 


5 


- 




21 


16 


10 


- 




- 


37 


20 


- 




- 


83 



e. It is seen that at 10 miles from a 10— megaton airburst, which is 
within the area where protection against blast could be effective, about 40 
seconds would elapse before arrival of the blast wave. If prompt action is 
taken, a person in a building could reach a position of the type indicated 
earlier. In the open, some protection against the blast may be obtained by 
falling prone, and remaining in that position until the wave has passed. In 
the prone position, with the head directly toward or directly away from the 
explosion, the area of the body exposed to the onrushing blast wave is rela- 
tively small and the danger of displacement is thereby decreased. 

1-15. SUMMATION 



The 
energy rel 
biast wave 
and can be 
burst. Th 
causes the 
i ncreased . 
pressure o 
pressure o 
degrees as 
name I y , d i 
env i ronmen 
injuries r 
of d i s— p I a 



blast and shock eff 
eased by a nuclear d 

moves outward from 

re i nf orced by the r 
i s wave i nteract i on 

overpressures in th 

D i f f ract i on— type t 

r crushing; drag— typ 

r tear i ng , tumb I i ng , 

severe, moderate, o 
rect i n jur i es assoc i 
tal pressure variati 
esu I t i ng from impact 
cement of the body a 



ect accounts for approximately 50 percent of the 
etonation, except under certain conditions. The 
the fireball at approximately the speed of sound 
eflected wave, depending upon the height of 
is known as the Mach effect, or Mach stem, and 
e region through which it passes to be greatly 
argets are those sensitive to static over- 
e targets are those sensitive to dynamic 

and displacement. Damage is classified by 
r I ight. Blast injuries are of two main types; 
ated with exposure of the body to the 
ons accompanying a blast wave, and indirect 

of missiles on the body or as the consequences 
s a who I e . 



MED447 



1-28 



Section III. THERMAL AND INITIAL RADIATION 



1-16. THERMAL RADIATION 

a. Fireball Development. 

(1) Almost immediately after a nuclear explosion, the weapon 
residues incorporate material from the surrounding medium and form an in- 
tensely hot and luminous mass, roughly spherical in shape, called the "fire- 
ball." Generally there is about 35 percent of the energy from the nuclear 
weapon appearing as thermal energy or thermai radiation. This thermal radia- 
tion will travel large distances through the air and will be of sufficient 
intensity to cause moderately severe burns of exposed skin as far away as 12 

miles from a 1-megaton explosion, on a fairly clear day. The warmth may be 
felt at a distance of 75 miles. Because of the enormous amount of energy 
liberated per unit mass in a nuclear weapon, very high temperatures are 
attained. These are estimated to be several tens of million degrees, com- 
pared with a few thousand degrees in the case of a conventional explosion. As 
a consequence of these high temperatures, a considerable amount of energy is 
released in the form of electromagnetic radiations of short wave length, 
initially, these are mainly in the soft x— ray region of the spectrum, but the 
x-rays are absorbed in the air, thereby, heating it to high temperatures. 
This heated air, which constitutes the fireball, in turn radiates in a 
spectral region roughly similar to that of sunlight received at the earth's 
surface. It is the radiation (ultraviolet, visible, and infrared) from the 
fi-reball, traveling with the speed of light, which is received at distances 
from the explosion. 

(2) For an airburst at altitudes below 50,000 feet, the thermal 
radiation is emitted in two pulses. In the first pulse, which lasts about a 
tenth part of a second for a 1— megaton explosion, the surface temperatures are 
mostly very high. As a result, much of the radiation emitted by the fireball 
during this pulse is in the ultraviolet region. Although ultraviolet 
radiation can cause skin burns, in most circumstances following an ordinary 
airburst the first pulse of thermal radiation is not a significant hazard in 
this respect. In contrast to the first pulse, the second radiation pulse may 
last for several seconds, e.g., about 10 seconds for a 1— megaton explosion; it 
carries about 99 percent of the total thermal radiation energy. Since the 
temperatures are lower than in the first pulse, most of the rays reaching the 
earth consist of visible and infrared (invisible) light. It is this radiation 
which is the main cause of skin burns of various degrees suffered by exposed 

individuals up to 12 miles or more, and of eye effects at even greater 
distances, from the explosion of a 1— megaton weapon. The radiation from the 
second pulse can also cause fires to start under suitable conditions. 

b. Thermal Radiation Effects. The main direct effects of thermal 
radiation on human beings are skin burns, generally called flash burns to 
distinguish them from flame burns, and permanent or temporary eye damage. 
Burns are classified by "degree"; first— degree burns being mi id in nature, 
roughly similar to moderate sunburn; they should hea i without special treat— 

MED447 1-29 



ment. Second-degree burns are associated with blister formation, and if a 
significant area of the body is involved, medical attention is necessary; 
third— degree burns which involve the entire thickness of the skin, can occur 
at shorter ranges. Indirect (or secondary) burns also occur and are referred 
to as "flame burns"; they are identical with skin burns that would accompany 
(or are caused by) any large fire no matter what its origin. In addition, 
individuals in buildings or tunnels close to ground zero may be burned from 
hot gases and dust. The effects of thermal radiation on the eyes fall into 
two main categories: (1) permanent (chorioretinal burns) and (2) temporary 
(flash blindness). Concentration of sufficient direct thermal energy, due to 
the focusing action of the eye lens, can cause the permanent damage. The 
focusing occurs, however, only if the fireball is in the individual's field of 
view. When this happens, chorioretinal burns may be experienced at distances 
from the explosion which exceed those where the thermal radiation produces 
skin burns. As a result of accidental exposures at nuclear weapons tests, a 
few burns of this type have been received at distances up to ten miles from 
explosions of approximately 20— kilotons energy yield. Temporary flash 
blindness" or "dazzle" can occur in persons who are too far from the explosion 
to suffer chorioretinal injury or who do not view the fireball directly. 
Flash blindness results when more thermal energy is received on the retina 
than is necessary for image perception, but less than is required for burn. 
From a few seconds to several minutes may be required for the eye to recover 
f unct ions. 

c. Protective Measures. If an individual is caught in the open or is 
near a window in a building at the time of a nuclear explosion, evasive action 
to minimize flash burn injury should be taken, if possible, before the maximum 
in the second pulse. At this time only 20 percent of the thermal energy will 
have been received, so that a large proportion can be avoided if shelter is 
obtained before or soon after the second thermal maximum. The major part of 
the thermal radiation travels in a straight line and so any opaque object 
interposed between the fireball and the exposed skin will give some 
protection. At the first indication of a nuclear explosion, by a sudden 
increase in the general illumination, a person inside a building should 
immediately fall prone, and, if possible, crawl behind or beneath a table or 
desk or to a planned vantage point. An individual caught in the open should 
fall prone to the ground in the same way, while making an effort to shade 
exposed parts of the body. Getting behind a tree, building, fence, ditch, 
bank, or any structure which prevents a direct line of sight between the 
person and the fireball will give a major degree of protection. Clothing of 
the proper kind provides good protection against flash burns. Materials of 
light color are usually preferable to dark materials because the former 
reflect the radiation. Clothing of dark shades abgorbs the thermal radiation 
and may become hot enough to ignite, so that severe flame burns may result. 
Woolen materials give better protection than those of cotton of the same 
color, and the heavier the fabric the greater the protection. An air space 
between two layers of clothing is very effective in reducing the danger of 
flash burns. Protection against eye injury is difficult, especially for those 
persons who happen to be facing the burst point. 

d. Factors Affecting Thermal Radiation. Several factors wi I I affect 
thermal radiation. 

MED447 1-30 



(1) Weapon size . The thermal output or pulse of weapons increases 
markedly with increasing yield of weapon. 

(2) Altitude of the weapon . The altitude at which a weapon is 
detonated will determine what fraction of its output is thermal. In a very 
high altitude burst there is much less atmosphere to be heated into a fireball 
and the nature of the electromagnetic output is considerably changed. In a 
subsurface burst, the thermal output is absorbed within a short distance below 
the surface and is not hazardous to personnel. 

(3) Atmospheric conditions . The degree of visibi I ity markedly 
alters the ranges at which thermal effects can occur. Cloud cover, fog, and 
rain all have definite and varying effects. 

1-17. INITIAL NUCLEAR RADIATION 

a. The nuclear explosion is accompanied by highly penetrating and 
harmful invisible rays, called initial nuclear radiation. One of the special 
features of a nuclear explosion is the fact that it is accompanied by the 
emission of nuclear radiation: gamma rays, neutrons, beta particles, and a 
small proportion of alpha particles. Most of the neutrons and a part of the 
gamma rays are emitted in the actual fission process, i.e., simultaneously 
with the explosion. The initial nuclear radiation refers to the radiation 
emitted within one minute of the detonation. Since the ranges of the alpha 
and beta particles are comparatively short, initial nuclear radiation may be 
regarded as consisting only of gamma rays and neutrons produced during a 
period of one minute after the nuclear explosion. Gamma rays and neutrons can 
produce harmful effects in living organisms. It is the highly injurious 
nature of these nuclear radiations, combined with their long range, that makes 
them such a significant aspect of nuclear explosions. Most of the gamma rays 
accompanying the actual fission process are absorbed by the weapon materials 
and are thereby converted into other forms of energy. Thus, only a small 
proportion of this gamma radiation succeeds in penetrating any great distance 
from the exploding weapon, but there are several other sources of gamma 
radiation that contribute to the initial nuclear radiation. Neutrons produced 
in fission are to a great extent slowed down and captured by the weapon 
residues or by the air through which they travel. Nevertheless, a sufficient 
number of fast (fission) neutrons escape from the explosion region to 
represent a significant hazard at considerable distances away. Shielding from 
initial nuclear radiations (gamma rays and neutrons) is not a simple matter. 
For example, at a distance of one mile from a 1— megaton explosion, the initial 
nuclear radiation would probably prove fatal to a large proportion of exposed 
human beings even if they were surrounded by 24 inches of concrete. Even 
though gamma rays and neutrons differ in many respects, their ultimate effects 
on living organisms are much the same. 

b. The fact that initial nuclear radiation can reach a target from 
directions other than that of the burst point has an important bearing on the 
problem of shielding. Adequate protection from gamma rays can be secured 
only if the shelter is one which surrounds the individual so that he can be 
shielded from all directions. Various types of building materials offer 
varying amounts of protection from initial nuclear radiation, but the more 

MED447 1-31 



massive the construction, the better the protection. On the outside, a simple 
one-man foxhole can provide some protection. 



Section IV. RESIDUAL IONIZING RADIATION 



1-18. INTRODUCTION 

A tremendous pulse of radiation is released from the fireball of a 
nuclear weapon at the time of detonation and shortly thereafter. This is the 
initial radiation which has been previously discussed. It does not end the 
radiation problem. In fact, in a very real sense, the problem of dealing with 
radiation from the nuclear burst may be just beginning. Initial radiation is, 
by definition, over in a minute, and there is not much that can be done about 
it which was not done prior to the burst. However, there are other sources of 
radiation which will continue to present a problem for some time after the 
bomb is detonated. This radiation which continues after that first minute of 
initial radiation is called residual radiation. Residual radiation poses a 
much greater problem to the military officer than does the initial radiation, 
because he must deal with it over some period of time. The effect of this 
residual radiation on troops and the success of military missions will be 
determined by the judgment exercised in making decisions relative to this 
res idua I rad i at ion . 

1-19. TYPES OF RESIDUAL RADIATION 

a . General . 

(1) There are two general types of residual radiation which may be 
of military significance; these are induced radioactivity and rad i o I oq i ca I 

fa I I out . Residual radiation delivers its dose of radiation to personnel over 
quite a long period of time (hours, days, or weeks), while initial radiation 
doses are delivered almost instantly. Residual radiation also differs from 
initial radiation in that it contains no neutrons, whereas neutron radiation 
is a very important component of initial radiation. Both types of radiation 
include gamma, beta, and alpha radiation. Beta radiation is of limited 
importance in residual radiation, but is of no concern in initial radiation 
because the short range of beta particles restricts it to the fireball. In 
fallout environments, individuals can come into direct contact with materials 
emitting the beta radiation. Under these conditions, beta radiation may be 
s i gn i f i cant . 

(2) Since initial radiation emanates from the fireball, essen- 
tially it reaches the individual from a point source in space. Residual 
radiation, on the other hand, reaches the individual from what is ca I led an 
extended source. Generally, it comes from a two— d imens i ona I source — a circle 
around the individual on the ground. This is true for both the induced radi- 
ation area and fallout. In addition, fallout, while in the process of des- 
cending, emits radiation from a three— d imens i ona I source, since some of the 
radioactive material is in the air as well as on the ground. 



MED447 1-32 



(3) Generally speaking, residual radiation is less energetic than 
initial radiation. Therefore, it is less penetrating and is easier to protect 
against by shielding than initial radiation. 

b. Induced Radiation. 

(1) The two principal categories of residual radiation have been 
mentioned: induced radiation and fallout. Induced radiation is emitted from 
radioactivity that is produced in the surface in the vicinity of a nuclear 
weapon detonation. Neutrons can be captured by certain materials in the sur- 
face, converting them to unstable atoms which will emit radiation over a 
period of time. Fallout, the other major source of residual radiation, 
results from fission products in the nuclear cloud which slowly settle back to 
earth as the cloud drifts downwind. 

(2) When a nuclear weapon is detonated, a tremendous flux of neu- 
trons is released. Some of these neutrons strike the earth's surface and 
penetrate up to 18 or 20 inches. Most substances in the soil are not affected 
by neutrons; however, there are certain constituents of the soil which become 
radioactive when they capture neutrons. Some of these elements are: sod i urn , 

a I urn i num . manganese , iron , and s i I i con . Different types of soils contain 
varying quantities of these materials which can be made radioactive by 
induction; therefore, the area where the weapon was burst will influence the 
amount of radioactivity produced. Even small quantities of these elements may 
become highly radioactive when irradiated with neutrons. 

(3) Induced radioactivity is also produced by surface bursts; but 
under these circumstances, it is usually completely overwhelmed by the fallout 
prob I em. 

(4) The induced radiation area is characterized by its localized 
circular pattern. Since the neutrons producing the induced radioactivity 
leave the fireball in all directions, they intersect the earth in a circular 
pattern with the greatest quantity of neutrons striking the surface directly 
beneath the point of burst. Thus, the pattern shows the highest levels of 
induced radioactivity at the center of the circle, and this gradually 
diminishes as one moves from the center of the circle to the periphery of the 
pattern. Weather conditions have no effect on this pattern, since wind, rain, 
temperature, and all other meteorological factors do not affect the path of 
the neutrons. 

(5) The induced radiation area is most difficult to decontami- 
nate. Other types of radiological contamination generally result from the 
depositon of radioactive dusts on the surface. The penetration of neutrons 
may actually create radioactivity within the surface to a depth of several 

inches. Decontamination of the surface within the induced pattern by removal 
of the surface requires the removal of the top 4 to 6 inches of soil. Even 
though the pattern of induced radioactivity is small when compared with a 
fallout pattern, the removal of the surface material to such a depth presents 
a formidable problem. 



MED447 1-33 



(6) The decay characteristics of induced radioactivity are con- 
siderably different from those of fallout. Fallout material (fission prod- 
ucts) consists of a complex mixture of many radioactive isotopes and daugh- 
ter products of decay. Induced radioactivity, on the other hand, is produced 
in relatively few elements within the soil. Therefore, the decay of this 
induced radioactivity will vary with soil composition. 

(7) Because of the small size of the pattern of the induced area, 
it is not of great significance in military operations. Combat forces may 

move into areas of induced radioactivity within an hour or two of the burst 
while dose rates are still rather high. Through judicious use of instruments 
and by avoiding the center of the pattern, doses can still be kept very low. 
Passage through the area in vehicles, particularly armored vehicles, will 
reduce the time of exposure and give considerable protection through shield- 
ing. The most difficult military problemwould be posed in the situation 
which required forces to occupy a vital piece of terrain which was involved in 
the induced pattern. This problem may be solved by occupying the position in 
a horseshoe or doughnut-shaped pattern and by digging foxholes in conjunction 
with scraping back the top six inches or so of earth around the foxhole. 
There is not much I ikel i hood that a mission wi I I exist in this area for 
med i ca I un i ts. 

c. Radioactive Fallout. 

( 1 ) Genera I . Fallout presents a much more serious military 
problem than does induced radiation. When a nuclear weapon is burst close to 
the surface of the earth so that the fireball intersects that surface, radio- 
logical fallout may be expected. When the weapon is detonated, the fission 
process produces many new atoms which are radioactive. They are unstable, and 
in reaching stability they will eventually emit one or more types of 
radiation. The quantity of radiation represented by these fission products is 
truly enormous. In the fireball, these fission products are vaporized so that 
when they later condense or solidify as the cloud rises, they are extremely 
small particles. When the weapon is detonated in the air, these fission 
products remain in the form of very tiny particles which drift downwind with 
the cloud, settling back to earth so slowly that they are eventually 
distributed over a vast area, sometimes over half of the earth's surface, and 
not until months or even years after the burst. Thus, fission products from 
airbursts emit much of their radiation harmlessly high in the air, and they 
never become sufficiently concentrated on the earth's surface to constitute an 
acute hazard. 

(2) Loca i /ear I y . On the other hand, when the weapon is burst 
close enough to the earth's surface for the fireball to touch that surface, 
quantities of debris from the surface are picked up in the fireball. These 
are mixed with the vaporized fission products in the fireball. When the 
fireball cools sufficiently, the vaporized fission products condense as in the 
airburst, but much of this condensation takes place on particles of debris 
from the earth's surface. Since these debris particles are much larger than 
the fission particles, they tend to settle out of the nuclear cloud as it 
drifts with the wind, carrying the radioactive fission products with them. 
Thus, radioactive materials are carried back to the earth's surface within 

MED447 1-34 



hours and concentrated in a pattern which, while it may be large (several 
thousand square miles), is sufficiently covered with radioactive materials to 
represent a hazard to life. This is called "local" fallout. The area covered 
with radioactive materials in this way is called the fallout pattern or area. 
"Local" fallout is defined as that which reaches the ground within the first 
24 hours after the detonation and within several hundred miles of ground zero. 

(3) Wor Idwide fal lout . 

(a) There is another type of fallout, the so— called "world- 
wide" fallout. Worldwide fallout originates in two ways: When a nuclear 
burst produces local fallout, it also produces finely divided fission prod- 
ucts which, by chance, have no opportunity to condense upon surface debris. 
These remain very finely divided particles and fall to earth very slowly. 
They may be in the troposphere for several weeks, months, or years before 
settling back to earth. The other source of worldwide fallout is the very 
large megaton weapon. This weapon is so powerful that its rapidly rising 
nuclear cloud strikes the tropopause with such force that it is able to pene- 
trate through into the stratosphere. The tropopause is a temperature inver- 
sion layer between the troposphere (where we live) and the stratosphere. This 
layer acts as a barrier to the cloud from kiloton nuclear weapons, but not to 
the larger megaton weapons. When radioactive materials from nuclear clouds 
break through into the stratosphere they do not readily repenetrate the 
barrier formed by the troposphere; therefore, they do not return to earth 
rapidly. It takes a matter of years for even half of the material to make its 
way down through the tropopause to eventually be carried back to earth with 
prec i p i tat ion . 

(b) The worldwide fal lout is not a mi I itary problem. By the 
time this radioactive material reaches the earth, most of its radiation has 
been dissipated and it is so widely scattered as to require special, low 
reading laboratory instruments to even detect its presence. This is the 
"strontium 90' problem which is a subject for debate by philosophers and 
geneticists. There are other sources of fallout. - No fission process is 100 
percent efficient. Therefore, some unfissioned nuclear fuel will be present 
in the cloud and in the fallout. These nuclear fuels are alpha emitters. So, 
besides the beta and gamma radiation from fission products, fallout will 
contain alpha emitters. Also, elements of the bomb casing and in the soil or 
structures in the target area are all susceptible to conversion to radioactive 
materials through neutron induction. In some cases these induced radioactive 
materials may have a significant effect upon the fallout decay character- 
istics, causing decay to take place more or less rapidly than predicted. 
These induced radioactive materials are, of course, gamma and beta emitters 
just as are the fission products. 

(c) Nevertheless, the principal source of radiation in 
fallout remains the fission products themselves. Induced radiation will only 
rarely produce significant change in decay characteristics and will simply add 
its gamma and beta radiation to the total fallout problem. 

d. Factors Affecting the Pattern. Fallout patterns can vary con- 
siderably in size, shape, and in the degree of hazard presented. There are 

MED447 1-35 



many factors which can influence the fallout pattern. Some of these are the 
yield and design of the weapon, the height of burst, meteorological con- 
ditions, and the nature of the terrain. 

(1) The fission yield of the weapon determines the amount of 
fission products produced, and, therefore, the total quantity of radioactive 
material available. The fission yield is a function of weapon design as well 
as total weapon yield. The total number of neutrons which escape from the 
weapon is also a function of weapon design. Since the total number of neu- 
trons available for induction of radioactivity determines the quantity of 
induced radioactivity which may be present in the eventual fallout, it can be 
seen that the design of the weapon and its fission yield both determine the 
total quantity of radioactive material in the atomic cloud and the amount 
available for fallout. The total weapon yield also helps to determine the 
height to which the cloud will rise, and therefore, the size of the fallout 
pattern . 

(2) The height at which a nuclear weapon is burst will determine 
the quantity of debris in the cloud upon which radioactive materials can con- 
dense. The more debris in the cloud and the larger the particles, the sooner 
they will return to earth and the smaller the fallout pattern. Also, the dose 
rates will be higher within the smaller pattern. Generally, then, when 
weapons are burst high in the air but still low enough for the fireball to 

intersect the surface), the larger the fallout pattern, the less concentra- 
tion of radioactive material in the pattern. 

(3) Terrain may affect the fallout pattern in two ways. First, 
the composition of the soil directly beneath the burst will determine the 
quantity and type of induced radioactive materials which find their way into 
the fallout; second, the nature of the terrain over which the cloud passes 
will have its effect on the pattern, principally through the production of 

local "hot spots" or "skip areas." Local wind currents are usually a func- 
tion of the terrain over which they occur. 

(4) Meteorological conditions obviously have a tremendous effect 
upon the size and shape of the fallout pattern as well as its location. Of 
all meteorological factors, winds have the greatest effect upon the pattern. 
Wind direction determines the location of the pattern, and wind velocities 
determine its shape. It is not just the surface wind which affects the 
fallout pattern, but all the winds between the top of the nuclear cloud and 
the ground. All of the winds which are going to affect a nuclear cloud are 
called the "effective" wind. This effective wind will indicate the velocity 
and direction in which the cloud will move and fallout will form. Naturally 
the larger particles in the cloud will fall faster than the smaller particles 
and will be affected less by winds as they fall. These larger particles fall 
closer to ground zero, and since they generally carry more radioactivity, form 
the "hottest" part of the fallout pattern. The highest dose rates are found 
at the center line of the pattern. The familiar elongated downwind fallout 
pattern is formed from the throw out area at ground zero, gradually decreasing 
in dose rate until the pattern fades into background radiation levels at some 
distance from ground zero. The direction of the effective wind determines the 
direction of the long axis of the fallout pattern, and the magnitude of the 

MED447 1-36 



effective wind determines whether it will be long and narrow or short and 
broad. The faster the effective wind, the longer and narrower the resulting 
pattern . 

(5) Other meteorological factors will affect the fallout pattern. 
Notable among these is rain or other precipitation. If precipitation falls 
through all or part of a drifting nuclear cloud, it scours some of the radio- 
active material from the cloud and carries it to earth in greater concentra- 
tion than would otherwise develop. This is called "rain out." Smaller nuc- 
lear bursts of less than 10 KT do not push their clouds high enough to pass 
over the rain clouds, which generally drift at about 15,000 feet in temperate 
zones. In this case, even an airburst of 10 KT or below could result in sig- 
nificant local fallout — or rather, rain out. For surface bursts, while 
fallout is in progress some portion of the cloud is always below the level of 
rain clouds, and therefore, rain out could occur. Airbursts of large weapons 
are not subject to rain out because their clouds rise too high. 

1-20. NUCLEAR WEAPONS INTELLIGENCE REPORT 

a. NBC Reporting System. In view of the extent and influence of a 
fallout pattern, the tactical commander requires some items of intelligence 
following enemy use of nuclear bursts. He needs to know such items as loca- 
tion and type of burst, yield, and other elements which may be of intelli- 
gence value. The medical commander also requires some of these items in order 
to effectively perform his medical mission. Obviously, to be of value, this 
information must be rapidly disseminated on the battlefield. To facilitate 
the timely transmission of this material, a series of five NBC reports has 
been standardized throughout NATO. 

b. Observation. 

(1) There are several observations that can be made when the enemy 
employs a nuclear weapon. These include illumination time, azimuth towards 
the attack, location, delivery means, type of burst, f I ash— to— bang time, 
crater dimensions, cloud width and stabilized cloud top or bottom elevation. 
This intelligence information is necessary in order to alert other 
headquarters of the burst and to provide necessary information for estimation 
of yield and fallout prediction as required. The NBC reporting system con- 
sists of an alphabet wherein each item designates one and only one item of 
information. The meaning of each of the letters is found in Appendix A, GR 
76-332-100, page A-6 through A-11. Note: cGy and rad can be used 
interchangeably throughout this subcourse. 

(2) These letter items are used in one or more NBC reports. For- 
mats for the five NBC reports are found in Appendix A, GR 76—332—100, pages 
A— 6 through A-8. Artillery units have primary responsibility for reporting to 
the NBC element. Other units are responsible for making the basic 
observations for their own information and processing by unit NBC personnel. 
Normally, this information will not be transmitted to other headquarters or 
units. An NBC— 2 report is compiled from two or more NBC— 1 reports and 
represents an evalua— tion of data from the basic reports. The NBC— 5 message 
provides a means for the NBC element to disseminate information concerning 

MED447 1-37 



confirmed dose rates on the ground. This may be done by means of a trace or 
overlay of isodose rate contour lines or by the message format of the NBC-5 
report . 

(3) The NBC-4 report is a report of radiation dose rates at the 
reporting unit or other specified location. Note that the location of the 
reading, the dose rate, and the time are minimum reporting facts. 

(4) The NBC-3 message is a fallout prediction prepared by the NBC 
element at division and higher levels. It contains all the necessary infor- 
mation for receiving units throughout the command to plot a fallout predic- 
tion on the i r maps . 

(5) There is one additional message that, although not a part of 
the standardized NBC reporting system, plays an extremely important role in 
fallout prediction. The Effective Downwind Message transmits wind speeds and 
directions for six different yield groups of nuclear weapons. This infor- 
mation is compiled by the NBC element and disseminated throughout its area of 
responsibility. The basis is wind data provided periodically by the Air Force 
or Artillery. The format is found in Appendix A, GR 76—332—100, page A— 14. 

1-21. FALLOUT PATTERN 

Fallout has the potential to severely restrict operations of the nu- 
clear battlefield. Because of this, procedures for predicting fallout and the 
implications of these fallout predictions on operations have been developed. 

a. General. There are two nomograms with which one should become 
familiar prior to entering into a discussion of procedures for predicting 
fallout. The nomogram in Appendix A, GR 76—332—100, page A— 37, is used to 
determine cloud radius directly from weapon yield. Cloud radius is deter- 
mined by connecting the left and right— hand yield columns with a straight edge 
and noting the cloud radius under the straight edge in kilometers. The cloud 
radius is always rounded up to the nearest whole number. For example, a cloud 
radius of 2.5 km is rounded up to 3 km. The nomogram in Appendix A, GR 76— 
332—100, page A— 36, is used to determine the downwind distance of Zone I. The 
estimated weapon yield is connected with a straight edge to the effective wind 
speed (from the Effective Downwind Message) and the Zone I downwind distance 
read under the straight edge in kilometers. Again, round up to the next 
higher whole number. The downwind distance of Zone II is twice the Zone I 
distance from ground zero. 

b. Overall Area. In a nuclear warfare situation, a commander will 
have several questions concerning enemy nuclear surface bursts. He must know 
the direction fallout is moving, the speed at which it is moving, and the 
potential radiation hazard within his area of influence. The Army fallout 
prediction predicts an area wherein there is a high assurance that fallout 
will occur. This area is laterally defined by radial lines extending out from 
ground zero, and usually 40 degrees apart. The downwind boundary is defined 
by the Zero II arc between the lateral boundaries. This fallout predicted 
area is actually larger than the area in which fallout is expected to occur 
and the boundaries are not absolute; that is, some fallout will probably occur 

MED447 1-38 



outside the predicted area. However, barring major wind changes, all military 
significant fallout should occur somewhere within the area. In an attempt to 
answer the question as to the potential radiation hazard within the predicted 
area, it is subdivided into two areas within which exposed, unprotected 
personnel may receive significant total doses of radiation. 

c. Procedures for Prediction of Fallout. To satisfy command 
requirements at all echelons, two procedures for predicting fallout have been 
adopted. The primary procedure is the deta i I ed method employed by the NBC 
element at division and higher headquarters and disseminated throughout the 
command by means of an NBC— 3 message. The supplemental procedure is a 
s imp I i f i ed method that can be used by any unit in the field. Procedures for 
these methods are found in Appendix A, GR 76—332-100, page A— 31. Perhaps the 
most important step in processing a fallout prediction is to analyze the 
potential situation in the area of concern and adjacent areas. The calcu- 
lating and plotting is worthless without this last important step; for from 
this will emerge decisions as to required reactions for protection of person- 
nel. Although a fallout prediction has several inherent inaccuracies, it 
still is the best protection in the unit area. 

1-22. PRINCIPLES OF PROTECTION 

a. General. When it appears likely that fallout is appearing, there 
are two courses of action available — evacuation of unit to a new location or 
staying in the fallout area. Evacuation from the threatened area into an area 
of no fallout seems the most logical, but many other things must be considered 
in making this determination. What are some of the determinants? What are 
some of the factors that a commander must take into consideration? 

b. Important Considerations. 

(1) The most important determinant in a situation like this, as in 
any situation, is consideration of the miss ion of a unit. This mission is the 
only reason for the unit to be in a situation of nuclear war. The mission of 
treating the injured and the sick and getting them back to duty is the prime 
cons iderat i on. 

(2) Transpor tat i on is vital if the unit is going to move from one 
area to another. Is there enough transportation organic to the unit to move 
all of its patients, all of the personnel, and all of the equipment? If there 
is not enough organic transportation, is it available from other units? 

(3) Another determinant is " she I ter . " Shelter is a necessary part 
of operations in nuclear warfare. Shelter is needed for patients and 
personnel in order for them to survive. Three things are necessary for 
survival in nuclear warfare. One of these is RADIAC instruments to detect the 
presence of radiation; another is shelter, in order to continue operations; 
and the third is an exposure control system for personnel and patients. This 
will preclude one person going outside to shake off the top of the dozer 
trench each time, or one person continually going out to refuel the generator, 
or one person being continually on the trash detail to remove the rubbish that 
accumulates. This exposure control system also implies that a record of the 

MED447 1-39 



radiation exposure to those individuals that get a greater exposure than the 
normal person and the average dose to the rest of the personnel and patients. 
This is important when the commander considers radiation history. 

(4) Another determinant of importance is the " enemy act i on . " Just 
because the enemy has used a nuclear weapon does not mean that he is going to 
throw up his hands and shout: "It is all over! We have done it now! We have 
shot a nuclear weapon!" Remember that the idea of most wars is to acquire 
land and people — that the enemy is going to follow up his nuclear strike with 
ground forces to take and hold the ground. As a consequence of this, 
consideration must be given to: "Is the enemy advancing? Is he overrunning 
the units?" 

(5) Radiation history of the unit must be considered. There 
should be an exposure control system along with shelters and RADIAC instru- 
ments, which are a necessary part of the operation in nuclear warfare. This 
exposure control system can give an idea of what sort of radiation dosage that 
the unit as a whole has suffered. 

c. Protection from Radioactive Fallout. Protection may be achieved by 
three principles: distance, time, and shielding. If all three principles 
could be applied, the operation of a medical unit could be continued. 

(1) D i stance . The sun is very intense in the amount of heat 
energy that it releases, but only a small portion of that energy is received 
on the face of the earth. The distance between the earth and the sun is the 
protection factor. Distance between the source of radiation and people will 
give a like degree of protection. Consider a person sitting in the center of 
the room, as opposed to a person sitting beside the wall. The person sitting 
near the wall would be closer to a source of fallout on the outside and would 
get a greater dose of radiation than the person sitting in the center of the 
room. Consider the soldier who is in the middle of a uniform fallout field. 
Actual ly 50 percent of his dose is coming from within a circle of 10 meter 
radius around him. If he can keep the source of radiation 10 meters away from 
himself, the soldier will have reduced his radiation exposure by about 50 
percent . 

(2) T ime . All radioactive materials decay with the passage of 
time. In fallout, there are many different fission products: some with very 
short half— lives in the range of milliseconds, and some with very long half- 
lives. Time will help reduce the dose rate as the radioactive materials 
decay . 

(3) Sh ie I d i ng . The third principle of protection, shielding, is 
merely putting something between the person and the source of radiation. A 
good source of shielding from gamma radiation used in the walls of X— ray rooms 
is lead and it is generally backed up by very dense concrete. Materials that 
protect from X— rays also give protection from gamma radiation. The greater 
the density of the material, the better will be the protection. Shielding 
then from gamma is a combination of mass and thickness of the material used. 
On the nuclear battlefield the materials that are available will have to be 
used and what is lacked in density of material will have to be made up in 

MED447 1-40 



thickness of the material. The thickness of material which will reduce the 
radiation dose rate to one— half its original value is known as the half— value 
layer (HVL) . Some typical half— value layers are: 0.7 inch steel; 2.2 inch 
concrete; 3.3 inch dirt; 4.8 inch water; and about 9 inch wood. Thus 4.4 
inches of concrete will reduce the radiation intensity to 1/4 of the original 
value (1/2 times 1/2). Another term commonly used to express the efficiency 
of a shelter is transmiss i on factor (TF) . By definition: 



inside dose (or dose rate) 
TF = 



outside dose (or dose rate) 



therefore, the TF will always be a fractional number less than one. The third 
term is protection factor (PF) and that is the inverse of transmission factor, 
or, 



outside dose (or dose rate) 

PF = 

inside dose (or dose rate) 

The PF for a shelter will always be greater than one. 



(4) Exampl es . 

(a) Earth, a commodity that is normally afforded everywhere, 
has a rather good value as shielding, with a half— value layer of thickness of 
3.3 inches. So a bunker or a building covered with a few feet of earth will 
provide some protection from gamma radiation. 

(b) Consider the walls of a building with about 13 inches of 
concrete. Concrete has a half— value layer thickness of 2.2 inches; so this 
would mean that walls constitute about six half-value layers. What would be 
the dose rate on the inside if the dose rate on the outside was 100 rad/hr? 
There would be six half— value layers to work with. One half— value layer would 
reduce the inside to 50 rad/hr; two half— value layers would reduce the 
dose/rate to 25 rad/hr; three half— value layers would reduce it to 12 1/2 
rad/hr; four layers to 6 1/4 rad/hr: five layers to 3 1/8 and the sixth half- 
value layer down to about 1 1/2 rad/hr. 

(5) Civil defense . Civil defense has spent millions of dollars in 
trying to find what will be the best shelter available to people. They have 
considered many types of buildings and they have come to the conclusion that 
the subbasement of a multistory building will provide the best protection. 

The first floor of a one— story frame house provides a protection factor of 2. 
A protection factor is a measure of the amount of protection received from a 
certain shelter. It is a ratio of the outside dose of radiation to the inside 
dose; so as the protection factor gets larger, more protection is available. 
Lightweight materials, not much thickness, combined with distance, have small 

MED447 1-41 



protection factors. Normally, as the density of building materials is 
increased, the thickness of the walls are increased because they must bear 
more load — so in the subbasement of a multistory building, there is a great 
thickness of walls, a large distance from the outside to the center of the 
inside, and a lot of earth surrounding the subbasement. 

(6) Field expedient shelters — foxholes. 

(a) In many locations there will not be an existing building 
available, so one must rely on field expedient shelters, which are shelters 
developed as the need arises. A soldier who is standing in the middle of a 
fallout field is being hit by various components of gamma radiation from all 
sides. Perhaps his only solution is a foxhole where he gets a great deal of 
shelter by merely getting beneath the surface of the earth. If this partic- 
ular soldier had merely squatted down, he would have achieved more protection 
because he would have increased the distance that the radiation has to travel 
before h i tt i ng h im. 

(b) Any device that can be used to reduce the dose of 
radiation that personnel may receive, may be of great importance to future 
health. The foxhole is an excellent fallout shelter for the individual. The 
Army Medical Department's mission is to provide appropriate care for their 
patients. Field expendient shelters assume a larger proportion than a simple 
individual foxhole. A dozer trench is commonly used. The dozer trench is 
constructed using a bulldozer to cut the desired width, length, and depth in 
the ground. The dozer trench, must accommodate liter patients and allow 
adequate room for medical personnel to move freely among the patients. This 
shelter has a protection factor ranging from 7—10 because of reduced amounts 
of radiation permitted to interact with the patients. Additional protection 
can be provided by using a piece of canvas material as a cover and 
periodically having personnel dust off the canvas or throw it back in order to 
remove the fallout that may have landed there. The canvas alone will not give 
any protection from the standpoint of keeping the fallout particles at some 
distance from the individuals and patients. The dozer trench is not a good 
shelter from the standpoint of having things such as running water, or 
electricity, or waste disposal, or heating system, but it still will provide 
protection from fallout and it can be easily constructed. 

(c) Several field expedient shelters have been experimented 
with. The sandbag tent offers a protection factor of about 4 but it takes a 
very large amount of manpower and materiel to sandbag all the tents in an 
evacuation hospital. Perhaps this might be done to one tent, perhaps a com- 
mand post, or perhaps the operating room in order that a procedure in process 
would not be interrupted by having to go to a shelter. The dug— in tent offers 
a protection factor of about 5, but it also takes a large amount of engineer 
support. 

d. Summary. Protection from fallout is achieved by three princi- 
ples: distance, time, and shielding; time must pass before radioactivity 
decays, resulting in a lesser dose of radiation; dense thick shields reduce 
the intensity of the radiation, thus reducing the dose received. In reacting 
to the threat of fallout, the commander may decide to stay in place or to 

MED447 1-42 



evacuate. He makes this decision based primarily on the mission, but he cer- 
tainly will consider transportation, shelters, enemy action, radiation his- 
tory, and perhaps many more variables, such as supply, communication between 
units, and others. 



MED447 1-43 



EXERCISES, LESSON 1 

REQUIREMENT. The following exercises are to be answered by marking the 
lettered response that best answers the question; or by completing the 
incomplete statement; or by writing the answer in the space provided at the 
end of the quest i on . 

After you have completed all the exercises, turn to "Solutions to 
Exercises" at the end of the lesson, and check your answers with the 
so I ut i ons . 

1. List the three distinct casualty producing effects of a nuclear 
weapons detonation. 



nitial or prompt nuclear radiation is emitted during tne first 
after a nuclear weapons detonation. 



3. What percentage of total energy released at the time of a nuclear 
weapons detonation is the shock or blast effect? 



4. What percentage of total energy released at the time of a nuclear 
weapons is the thermal effect 9 



List the three type of nuclear bursts, 



6. A ps i of 5 coincides with approximately mph wind 

ve I oc i ty . 



MED447 1-44 



7. List three factors which affect thermal radiation. 



8. Two types of burns, caused by thermal radiation, are and 



9. Which of the following had charge of the Manhattan Engineering 
proj ect? 

a. Edgar Sengier. 

b. Klaus Fuchs. 

c . Willi am Parsons . 

d . Les I i e R. Groves. 

10. List the four basic types of nuclear reactions. 



11. What reaction is utilized in thermonuclear weapons? 



12. What are the three basic components of atoms' 



MED447 1-45 



13. List four basic differences between nuclear and h i gh— exp I os i ve 
weapons . 



14. What degree of burn is associated with blister formation? 



15. Which of the following NBC reports provides information concerning 
confirmed dose rates on the ground? 

a. 1 . 

b. 2. 

c. 3. 

d. 5. 



16. In seeking protection from fallout, which of the following factors 
must be considered by a commander? 

a. Mission of the unit. 

b. Transportation available. 

c . She I ter ava i I ab I e . 

d. Anticipated enemy action. 

e. Unit radiation history. 

f . Al I of the above. 



MED447 1-46 



SOLUTIONS TO EXERCISES, LESSON 1 

1. Blast and shock, thermal radiation, and nuclear radiation, 
(para 1-9a(4) (a)-(c)) 

2. 60 seconds or 1 minute. (para 1— 9a(5)) 

3. 50'/. (para 1-9a(4) (a)) 

4. 35% (para 1-9a(4) (b)) 

5. Subsurface burst; surface burst; and airburst. (para 1— 9b ( 1 ) — (3)) 

6. 160 mph (para 1-10c (2) ) 

7. Weapon size; altitude of weapon; and atmospheric conditions, 
(para 1—1 6d (1)-(3)) 

8. Flash and flame burns. (para 1— 16b) 

9. d (para 1-1f) 

10. Scatter; capture; fission; and fusion. (para 1-4g) 

11. Fusion. (para 1— 6a) 

12. Proton; neutron; and electron. (para 1— 4e) 

13. Nuclear explosion can be a great many times more powerful; a fairly large 
proportion of energy in a nuclear explosion is emitted in the form of 
light and heat; nuclear explosion is accompanied by initial nuclear 
radiation; and substances remaining after a nuclear explosion are 
radioactive. (para 1— 8b) 

14. 2nd degree. (para 1— 16b) 

15. d (para 1-20b(2)) 

16. f (para 1— 22b ( 1 ) — (5) ) 



MED447 1-47 



LESSON ASSIGNMENT SHEET 



LESSON 2 

LESSON ASSIGNMENT 
MATERIALS REQUIRED 
LESSON OBJECTIVES 



SUGGESTION 



— Ionizing Radiation Injury. 

--Paragraphs 2-1 — 2-11. 

— None. 

— After completing this lesson, you should be able to: 

2—1. Discuss the acute radiation syndrome. 

2—2. List the symptoms of acute radiation injury. 

2—3. Describe the recommended treatment for acute 
radiation injury. 

— After completing lesson assignment, complete the 

exercises at the end of this lesson. These exercises 
will help you to achieve the lesson objectives. 



MED447 



2-1 



LESSON 2 
IONIZING RADIATION INJURY 



2-1. INTRODUCTION 

In addition to blast, thermal injury, and initial nuclear radiation 
from a nuclear weapon, which may produce a large number of casualties, 
residual radiation is emitted. It has a similar potential. This ionizing 
radiation injury may not be observed for days or even weeks. 

2-2. TYPES OF RADIATION 

a. An understanding of the ionizing radiation injury hazard associated 
with the use of nuclear and thermonuclear weapons requires a clear 
appreciation of the types of radiation produced by such weapons and their 
characteristics, especially with respect to their ability to penetrate deeply 
into the body. It must be understood at the outset that many variables, 
including the type and energy of the radiation, the time during which it is 
received, the presence or absence of associated injuries, the extent of the 
body exposed, individual biological susceptibility, and, of greatest impor- 
tance, the total dose received influence the response in the irradiated 
victim. These variables are mentioned not to add confusion to a confusing 
problem, but rather to acknowledge their importance in arriving at a departure 
point for describing the syndrome of acute radiation injury. Any description 
which presumes to paint a cl inical picture of radiation injury must be based 
fairly firmly on the optimistic assumption that the dose received and absorbed 
is known. The difficulty in establishing this absorbed dose for an individual 
or group, especially in a situation of mass casualty production in warfare, is 
no minor one. 

b. Although an increasing variety of ionizing particles and rays 
exists, or can be produced in the laboratory, only alpha and beta particles, 
neutrons, and gamma rays are associated with the detonation of nuclear 
weapons. Of these, only neutrons and particularly gamma rays concern us in 
exploring the problem of large numbers of acute whole body ionizing radiation 
injuries. Both of these are present at the time of detonation while only 
gamma is present in the fallout. The assumption is made, too, that for whole 
body effects, neutrons are of the same biologic effectiveness as gamma rays in 
producing injury. (It is true, of course, that for specific organs or for 
particular effects, this assumption is not valid). Proceeding from this 
assumption, the abbreviation rad will be used to describe the unit of dose and 
may be considered to represent the roentgen, roentgen equivalent, the rad 
(radiation absorbed dose), or the rem (roentgen equivalent man). 



MED447 2-: 



2-3. SOURCES OF HUMAN DATA 

In the development of a typical clinical picture of the acute radiation 
syndrome, it is necessary to extract segments of information from a variety of 
sources to produce a complete and representative sequence of events. No one 
source alone is complete enough from the standpoint of dose information, dose 
range, medical documentation of early findings, numbers involved, and types of 
radiation to provide the data required. 

a. The Japanese bomb casualties, as they have come to be known, 
represent by a wide margin the largest number of human beings ever exposed to 
large doses of penetrating ionizing radiation. Documentation, particularly 
soon after the injury, was not good and dose determination was completely 
absent. Any conclusions must therefore be tempered by the basic mass of 
variables and unknowns entered into the problem. 

b. The Marshall Islands fallout radiation victims, injured as a 
consequence of an unpredicted yield change of the detonation of a 
thermonuclear device on Bikini Atoil in March 1954, are the second largest 
group. Included with the natives of the islands are 28 American servicemen 
and 23 Japanese fishermen, for a total of 290 persons. Unlike the Japanese 
group, the Marshall Islanders' clinical courses are very well documented, and 
a close approximation of the whole body exposure dose is available. The fact 
that the maximum dose received (discounting the contact beta particles skin 
dose) by a relatively small number of the victims was in the vicinity of 175 
rad is the major limiting factor on the data from this group. 

c. Laboratory and industrial accidents involving approximately 30 
individuals in the United States, Russia, and Yugoslavia constitutes a small 
but extremely valuable group from the viewpoint of medical data. This group 
is exceptionally well documented and encompasses a range of doses from trivial 
levels to many thousands of rad. Much useful information has been derived 
from these accident cases to fill gaps and round out the clinical picture. 

d. Clinical radiotherapy (X— ray, radium, and isotopes) provides a 
large, medically we I I— documented source of information of variable value. 
Local radiation therapy used beneficially on many patients over many years has 
led to the accumulation of a vast knowledge of local injury or effect, but 
lends little to knowledge of whole body effects. 

2-4. ACUTE RADIATION INJURY 

An understanding that not all tissues and cells are equally sensitive 
to radiation injury must be reached to appreciate the different clinical 
responses to varying doses. Cells which are rapidly growing and dividing, 
that is, undifferentiated cells, are most sensitive, while those that are 
fully differentiated are resistant. Certain tissues and cells, including the 
lymphoid, bone marrow, and Krypt cells at the small intestine are especially 
sensitive. Accordingly, at moderate doses, injury to them with the resultant 
under— product i on or over— product i on of their products (hormones, specialized 

MED447 2-3 



cells, enzymes, etc.), alteration of growth rate of population, or even death 
of the cells or tissues, predicts the type of clinical response. Other 
tissues and organs are moderately sensitive to such injury (parenchymal cells 
of the liver and kidney, vessels, adrenal, thyroid). In higher doses, injury 
to these cells predominates the clinical picture. Resistant or relatively 
resistant cells and tissues include nerve cells, bone, the eyes, and muscles. 
With large prompt doses, injury to these structures becomes manifest before 
injury to the more sensitive parts has time to reveal itself. 

2-5. THE SYNDROME 

The acute radiation syndrome follows total body receipt of gamma rays, 
neutrons, or both. The type and severity of response in man is, of all the 
variables, especially dose— dependent . In all that follows, it is presumed 
that all doses are received in a short period of time (i.e., up to 48 hours); 
the body is "uniformly" irradiated; no significant prior or concomitant injury 
(including radiation) exists; the dose is known; and the individual is 
average, i.e., neither excessively resistant nor excessively sensitive to 
radiation. If these conditions are accepted, the disease which follows 
irradiation can be classified on the basis of the major tissue, organ, or 
system injured as follows: (1) no obvious disease to slight symptoms; (2) 
diseases manifested by obvious injury to the blood and blood forming organs 
(the hematopoietic syndrome); (3) disease manifested by obvious injury to the 
organs of the gastrointestinal system (the gastrointestinal syndrome); and (4) 
disease manifested by obvious injury to the central nervous system (the CNS 
syndrome). The latter three are the sub— syndromes which amount to medical 
workload and loss of life. 

2-6. NO OBVIOUS DISEASE 

No obvious disease implies there is no apparent clinical symptomatology 
or disability, even though there may be demonstrable alteration of the blood 
and other tissue on laboratory analysis. The range of absorbed dose for this 
effect is perhaps to 100 rad. In times of disaster or in the presence of 
mass casualties, individuals in this category could be used to their normal or 
even maximum capacity providing further significant radiation exposure close 
in time to the initial insult is avoided. They require no treatment and 
certainly no hospitalization. Slight symptoms appear in individuals with 
doses between 100 to 200 rad; however, moderate rest and self— care will 
generally suffice for these cases (See table 2-1). 



MED447 2-4 





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MED447 



2-5 



2-7. THE "TYPICAL" ACUTE HEMATOPOIETIC SYNDROME 

The hematopoietic form of the disease will occur with a clinical 
severity related to the total dose absorbed in the range of 200 to 800 rad; a 
range associated with a lethality of from to 100 percent at the extremes. 
This is the form of the disease which is, or should be, of greatest concern, 
for it represents injury in which proper treatment may exert considerable 
influence on its course. Although individual biological susceptibility may 
dictate the severity of response of the blood and blood-forming tissues at a 
given dose, the type of response is uniform, and for the most part, 
predictable. A description of the "typical" hematopoietic form of the syn- 
drome, e.g., that which might be seen in an "average" individual after 
receiving 300 to 350 rad, provides a basis for understanding the clinical 
nature of the injury and the alterations that different doses, varying 
sensitivities, and treatment may make. The typical hematopoietic form of the 
disease is characterized by four phases: the prodromal phase, the latent 
phase, the bone marrow depression phase, and the recovery phase (see table 
2-1) . 

a. Initial Prodromal Phase. 

(1) Immediately following receipt of several hundred rad, e.g., 
300 to 350 rad, in our hypothetical victim, even when accumulated in an hour 
or less, there may be no subjective sensations or objective findings. Within 
one to several hours, abruptly or gradually, I ist I essness, fatique, 
disinterest, or even lethargy appear. (If the subject knows or suspects he 
has been exposed psychogenic invention or magnification of symptoms may be 
prominent and may serve to confuse or obscure the sequence of these events). 
These initial symptoms become increasingly more severe and are associated with 
headache, anorexia, followed by nausea, and finally, frank vomiting. Maximum 
severity of symptoms and associated incapacity are reached by the 5th to 8th 
hour, whereafter "recovery" begins with the complaints disappearing in reverse 
order of their appearance. Some authorities feel that the severity of nausea 
and vomiting in the prodromal phase may be directly proportional to the amount 
of food in the stomach at the time of injury and may be prolonged by attempts 
to refill it. By the end of the second day or the beginning of the third day, 
a state of comparative well— being is regained with mild cyclic fatique, in 
some instances, as the only residual. 

(2) Vomiting during the prodrome may be the only symptom of value 
in estimating the degree of radiation injury, providing good clinical judgment 
is used in evaluating it and the possibilities of psychogenic overlay are not 
forgotten. Vomiting that occurs late and is of short duration suggests a 
lower dose than that which occurs early and is severe and prolonged. In doses 
between 100 and 200 rad, vomiting may or may not occur. Marshall Brucer, 
however, admonishes us to remember that "The publicity on radiation accidents 
has been sufficient to instruct people that they should vomit." 

(3) The laboratory findings during the prodromal phase are, from a 
practical standpoint, limited to alterations in the peripheral blood. Although 

MED447 2-6 



serial bone marrow studies, mitotic indices, thymidine uptake determinations, 
examination of the urine for bizarre amino acid content, complicated enzyme 
studies, examinations of hair roots, and determinations of changes in platelet 
structure and number are possible, and might contribute individually or 
collectively to information desirable for dose determination, prognosis, and 
specific therapy, they represent laboratory maneuvers of considerable 
difficulty. Whether such expert technical assistance in adequate volume to be 
useful would exist in a mass casualty situation is doubtful. 

(4) The earliest changes in the peripheral blood involve a 
decrease in the lymphocyte count, occurring within hours, and fluctuations in 
the total white cell count, with probably a mild overall increase in the white 
blood cell count during the first few days. Si nee base line counts will not 
have been established, this fluctuation or mild elevation of the total count 
will have little or no diagnostic or prognostic value. On the other hand, the 
early lymphopenia is at least suggestive of radiation damage. It is 
pronounced with high doses and less remarkable with low doses. Experts 
disagree concerning the value of specific lymphocyte counts in prognosticat- 
ing. All agree, however, that a rising count after the first few days is an 
exceptionally good sign. 

(5) In summary, the prodromal phase of the hematopoietic form of 
radiation illness is a 2— or 3— day period characterized by signs and symptoms 
similar to those of motion sickness, and the laboratory findings are those of 
nonspecific mild leukocytosis with a relative and absolute lymphopenia. True 
diarrhea, contrary to earlier descriptions of the syndrome, is not character- 
istic of the hematopoietic form of the disease. 

b. Latent Phase. The latent phase begins on the third or fourth day, 
depending, of course, on the severity of the initial reaction. It persists 
for about 3 weeks from the time of exposure and is characterized by a 
remarkable freedom from symptoms. In a few individuals, persistent mild 
recurrent fatigue may disturb this deceivingly benign period. The laboratory 
findings in the early part of the phase, at least, also fail to suggest the 
severity of the disturbances to come. There is a progressive decrease in the 
total white cell count which is moderate for granulocytes and pronounced for 
lymphocytes. Near the end of the second week after exposure (12 to 18 days), 
the severity of the clinical course is disturbed by epilation — loss of hair in 
large quantities — an event which, from the patient's point of view, is of 
tragic significance. Since epilation occurs with exposures to more than 300 
rad, the sign is of significance only insofar as it attests to the proba- 
bility that the dose was at least that high to the parts that epilate. All 
body and head hair is subject to loss following a large enough dose of 
radiation, but the hair of the eyebrows and eyelashes is apparently less 
sensitive than that of other parts of the body surface. Except for the 
psychological trauma associated with this loss of hair, the subject continues 
to feel well and is able to perform his normal duties. In summary, the latent 
phase of the hematopoietic form is one of benign clinical course, associated 
with epilation in exposures exceeding 300 rad, and characterized 
hemato I og i ca I I y by marked lymphopenia. 



MED447 2-7 



c. Symptomatic Phase or Bone Marrow Depression Phase. 

(1) The bone marrow depression phase is heralded during the third 
week (18 to 21 days) by the return of signs and symptoms suggesting, at first, 
the onset of an acute infectious process. Chills, fever ishness, malaise, 
increased fatigability, and pharyngitis interrupt the heretofore symptom-free 
interval. Within the next few days the clinical picture deteriorates rapidly 
causing the patient to be hospitalized or, at least, confined to bed. The 
oropharynx becomes swollen with the gingiva (gums) and tonsillar areas showing 
the most marked reaction and beginning ulceration. As the disease progresses, 
a tendency to bruise easily or to bleed slightly from the gums (pink 
toothbrush) appears. Coincident with these findings in the mouth and on the 
skin, the general condition of the patient reflects the compromise that has 
affected his blood-forming organs. Streplike fever suggests septicemia and 
petechiae (pinpoint hemorrhages) and ecchymoses (black and blue areas) may 
involve broad zones of the skin. (In those patients who do not survive beyond 
this point as a result of the disease itself or another associated injury, 
these hemorrhagic phenomena can be shown to involve the lining and coverings 
of internal organs). Despite earlier predictions based on Japanese bomb 
casualty data, gross hemorrhage from the orifices and into the interior of the 
hollow organs will not be massive and continuous, but will be generally 

se I f— I imi t i ng . 

(2) The return of clinical illness and the signs, symptoms, and 
laboratory findings associated with it, define, rather precisely, the 
classical picture of acute aplastic anemia. The continuous fall in white 
cells and platelets, the ulcerations of mucous membrane, the septicemia and 
bacteremia from the breached defenses of the gastrointestinal tract lining, 
superimposed upon the inability of the white cell compartment to combat 
infection, present the serious clinical picture associated with severe bone 

marrow injury. 

(3) In the "typical" case these symptoms and findings reach a 
maximum severity between the fourth and fifth week, the critical period. 
Thereafter, recovery begins, manifested by gradual return of the temperature 
toward normal healing of the ulcerations of the mouth, throat, gums, clearing 
of the hemorrhage in the skin and mucous membranes, and beginning regrowth of 
lost hair. These improvements in general are a reflection of the return of 
bone marrow function with increase in the white cell components of the blood 
toward normal levels. Return of the lymphocytes, however, is very slow, and 
many months may pass before normal counts are observed. At this level of 
radiation, it can be anticipated that sperm production in the male and 
ovulation in the female of appropriate age will have ceased; return of these 
functions will not occur for a period of months. 

(4) In summary, the bone marrow depression phase of the syndrome 
is characterized by severely reduced numbers of white cells and platelets in 
the blood and marrow, due to interference with their production. The picture 
is one of aplastic anemia with its attendant bleeding phenomena and tendency 
toward infection. The course is serious to grave to fatal depending on dose, 

MED447 2-8 



susceptibility, and treatment. Death, when it occurs, usually intervenes at 
about the second month, and is due generally to uncontrolled, overwhelming 
i nf ect i on . 

d. Recovery Phase. 

(1) The recovery phase is, as the name implies, that period during 
which the clinical and laboratory alterations, having reached their maximum of 
severity during the bone marrow depression phase, continue to improve until a 
state of relative normalcy obtains. The period is of varying length, up to 3 
to 6 months, depending on the degree and duration of aplastic anemia, dose, 
individual response to treatment, and presence or absence of associated injury 
or major complication. Such major complications as pneumonia, multiple 
abscess formation, and bacterial resistance to available antibiotics can be 
expected to occur in a significant percentage of individuals, especially in a 
mass casualty situation. 

(2) In the dose range 100 to 200 rad, where clinical observation 
rather than actual hospitalization and specific therapy will be the rule, 
recovery for all can be anticipated. In other words, the prognosis is 
excellent and can be confirmed on the basis of numerous human cases. 

(3) In the dose range 200 to 600 rad, in which about 40 well- 
documented cases have occurred, the prognosis for recovery is generally good. 
Treatment in this range, especially at the upper extreme, may play the 
determining role in recovery. At the level of 600 rad, the LD 50 for man is 
approached, according to the proponents of high values for the 50— percent 
mortality dose. Equally competent authorities, extrapolating from available 
human data and animal experimentation, feel that 600 rad represents the near 
LD'100 for man, and that 450 rad, or even lower, is the appropriate LD 50. 

(4) In the dose range 600 to 800 rad, prognosis must be guarded. 
Treatment may improve chances for survival considerably in the lower part of 
the range, but as the upper limits are reached, the situation is increasingly 
hopeless until at 1,000 rad all, or nearly all, can be expected to die. 
Brucer's remark that the "area of immediate interest to physicians lies 
between the 100 and 800 rad levels. Above this level we are helpless and 
under this level, we are unnecessary," best describes the current philosophy. 

(5) In summary, the recovery phase, and convalescence which 
follows, consumes several weeks to many months depending on dose, response to 
injury and treatment, and demands to be placed on the survivors. In low 
ranges, it is rapid and short, and at the upper extreme, prolonged if it is 
reached at all. It must be emphasized that the form taken by the disease is 
dose dependent, but not sharply dose dependent as the extremes of each range 
are approached. For example, at 800 rad the bone marrow injury will continue 
to predominate the clinical picture, but evidence of injury to the 
gastrointestinal tract, described below, may begin to appear. There is, in 
other words, overlap of one form with another at appropriate doses. 



MED447 2-9 



2-8. GASTROINTESTINAL SYNDROME 

The gastrointestinal form of the acute radiation syndrome is seen when 
the acute dose has been between 800 and 3,000 rad, and is associated 
invariably with a fatal outcome. The prodromal phase is more abrupt in onset, 
violent in character, and prolonged in duration when compared to the 
hematopoietic form. Diarrhea is characteristic of the prodrome in this form 
of the disease. The prodromal signs and symptoms finally subside after 
several days and a short latent period follows. After a few days the symptoms 
of nausea, vomiting, diarrhea, and fever recur with increased fury, and death 
as a result of gross electrolyte and fluid balance defects results within 2 
weeks. Frank hemorrhage and epilation do not occur because the course of the 
disease is too short to permit these events to develop. The blood changes 
seen parallel those found in the high dose range of the hematopoietic form. 
Treatment, when the patient survives long enough to reach an agency capable of 
providing it, is palliative. With time and increased knowledge, beneficial 
therapeutic intervention may improve and prevent hopeless prognosis held for 
victims of this form of the disease (see table 2—1). 

2-9. CNS OR CEREBRAL FORM 

The cerebral form of the acute radiation syndrome is seen when the dose 
has exceeded 3,000 rad. Death within hours can be anticipated. A state of 
extremes is almost coincident with the time the total dose is received. 
Symptoms suggesting mortal insult to the brain and cord are predominant, and 
include explosive, transient nausea, vomiting, and diarrhea. Except for a 
prompt fall in lymphocytes, which may essentially disappear from the 
peripheral blood, the findings of leukopenia, bleeding, epilation, and 
infection, characteristic of the hematopoietic form, do not have time to 
occur. Irrational behavior, circulatory collapse, and neuromuscular discoor— 
dination occur within minutes. There may be some facultative recovery within 
hours, depending on dose and therapy instituted. Within a very short time, 
irrational behavior recurs with convulsions and coma preceding death 2 hours 
to 2 days (see table 2-1) . 

2-10. FIELD DIAGNOSIS 

Any good public health or preventive medicine officer, upon receiving a 
group of patients from one local area exhibiting prodromal symptoms, would 
immediately suspect an outbreak of food poisoning. In case of an actual 
nuclear situation, if you were within range of direct prompt radiation, it 
would be impossible to be unaware of the detonation. It would however, be 
possible to be in a fallout field, as were the Marshall Island natives, and 
remain totally unaware of exposure. From this you can see that the basis for 
diagnosis is awareness that an exposure has occured. Once it has been 
determined that people in a certain area were probably or possibly exposed, 
then the problem is of determining who was exposed and how much radiation did 
they receive. The prodromal symptoms observed with particular attention to 
severity and rapidity of onset will give a crude measure to distinguish 
perhaps tenfold differences in exposure, that is, to separate a 100 rad, 
1,000 rad, or 10,000 rad case. A dosimeter or other radiation dose measuring 
device, may be available to aid in estimation of dose; however, caution should 

MED447 2-10 



be used since individual instruments may be broken or malfunctioning, causing 
erroneous readings. Any individual having recent high dose exposure, i.e., 
over 100 rad within the last few weeks or months, may show abnormal severe 
symptoms due to residual damage from previous exposure. Further examination, 
observation, and laboratory tests of limited or no immediate value in the 
field will be of use to confirm early diagnosis. Altogether, the pieces will 
form a picture which will allow approximation of dose and thereby estimation 
of the injury to a group or individuals. In summary, early and severe onset 
of symptoms in individuals known to be exposed to radiation, together with 
dose reading from several instruments in the area of exposure, will allow a 
diagnosis of radiation injury. 

2-1 1 . TREATMENT 

a. Since there is no specific acute major pathology and no clearly 
understood reversible physiological, biochemical, or biophysical event or 
series of events, there is no specific therapy for acute radiation injury. 
Time and accumulated knowledge may eventually invalidate this statement, but 
>t is currently true. In the dose range of the cerebral form of the disease 
(3,000 rad or more), it can be anticipated, in major disasters resulting from 
thermonuclear yield weapons, that most individuals receiving their doses 
promptly will also be grievously injured by thermal or blast effects and will 
not survive long enough to be rescued. (For I ow— y i e I d tactical weapons, high 
dose pure radiation injuries are possible.) For those who acquire such large 
doses over a longer period, as in a failout field, hospitalization may 
possibly be accomplished, but treatment will be ineffective. 

b. In the range of doses likely to produce the gastrointestinal form 
of the disease (800 to 3,000 rad), patients in number may survive long enough 
to be hospitalized and receive early supportive therapy. The situation in a 
treatment facility with respect to numbers of other casualties of different 
types, avai ! abi!ty of supplies and personnel, and the presence or absence of 
associated injuries in the radiation victim will determine how much treatment 
is received. At the present state of the art, it is agreed that, although 
intelligent fluid and electrolyte replacement may postpone the fatal outcome, 
it is uni i ke I y that such an outcome can be avoided. 

c. In the dose range below 100 rad, no treatment in mass disaster will 
be indicated, or available. In the range of '00 to 200 rad, clinical 
observation and r eassurance may be all that is necessary. In sensitive 
individuals and those with associated injuries, hospitalization and treatment 

nay be necessary in doses between 200 and 250 rad. 

d. It is in the range of 250 to 800 rad in which intensive treatment 
correctly anticipated through understanding of the clinical sequence, and 
given at the appropriate time, can be expected to exert the greatest 
beneficial influence. Below 500 rad, treatment will ordinarily be 
conservative and will be directed primarily at the complications associated 
with the radiation injury (e.g., infection). Above 500 rad, where the 
prognosis becomes more and more unfavorable, a more radical approach is 
indicated wherein therapeutic procedures must be given in anticipation of 
signs and symptoms that have not yet become manifest. Injury directly related 

MED447 2-11 



to the radiation effect itself can be expected to proceed rapidly to a 
clinical climax. Manifestations of such insult include rapid, severe 
reduction in circulating white cell components, and fluid and electrolyte 
losses through severe persistent vomiting, and at high doses, diarrhea. 

e. The limitations of time and space, and the sheer magnitude of the 
problem, make it impossible to discuss treatment under all conceivable 
circumstances. A review of the procedures recommended under "ideal" 
conditions will enable one to predict the variations and compromises that may 
be necessary in a given environment. In mass disaster where dose 
determinations may not be practical, treatment and hospitalization may have to 
await the development of symptoms. 

f. During the first few hours (prodrome), patients estimated to have 
received more than 250 rad should be hospitalized. Severe early vomiting and 
skin erythema suggest high doses, and treatment or withholding of it in favor 
of others may have to be decided early. If there is an associated neutron 
exposure and if facilities are available to make measurements, a determination 
of induced sodium radioactivity may contribute to dose estimation. Sedation 
and the use of antiemetic drugs as indicated are the procedures available in 
the earliest stages. Psychological vomiting in the lower doses is, however, 
not managed by antiemetics. Fluid and electrolyte replacement in cases of 
severe vomiting may be necessary early. Brucer asserts, during the early 
phase, "Probably the most important therapeutic procedure that can be 
performed during the first few hours is to resist the temptation to load the 
patient with blood, drugs, and synthetic metabolic poisons." 

g. During the first few days, a definite pattern develops which should 
enable one to distinguish between high— dose and low— dose victims and to make 
appropriate determinations insofar as further supportive measures are 
concerned. In those for whom a distinct bone marrow depression can be 
predicted or anticipated, planned management must follow. 

h. At the beginning of and throughout the latent phase, there is no 
special indication for treatment. Patients, if they have been hospitalized, 
should remain there during this period. The situation may, however, require 
that they be discharged to await further developments. It must be emphasized 
that the serious events presenting the greatest therapeutic challenge do not 
appear, except in high— dose victims, until the second or third week. 

i. The bone marrow depression phase with its attendant problems of 
bleeding and infection is managed by the judicious use of fresh whole blood, 
if available, and broad spectrum antibiotics given when indicated and not 
prophy I act i ca I I y . The desirability of giving only platelets and white cell 
extracts of whole blood to patients with an adequate red cell count is 
obvious, but the ways and means of fulfilling this desire are not available, 
particularly with large numbers of patients. 

j. Bed rest, good nursing care, a nourishing easily digested diet, and 
anticipation of complications constitute the remaining therapeutic activities. 
Nothing specific is available to reverse or minimize radiation effects. There 
are no emergency or heroic measures known. Final success or failure when 

MED447 2-12 



faced by a nuclear situation will rest on thoughtful planning prior to the 
situation along with efficient management of the medical problems resulting 
from the nuclear detonation. 



MED447 2-13 



EXERCISES, LESSON 2 

REQUIREMENT. The following exercises are to be answered by marking the 
lettered response that best answers the question; or by completing the 
incomplete statement; or by writing the answer in the space provided at the 
end of the question. 

After you have completed all the exercises, turn to "Solutions to 
Exercises" at the end of the lesson, and check your answers with the Academy 
so I ut i ons . 

1. Which of the following has the greatest influence in the response of 
an irradiated victim? 

a. Type and energy of the radiation. 

b. Time during which radiation is received. 

c. Presence or absence of associated injury. 

d. Total dose received. 



List the sources of human data concerning nuclear radiation. 



3. In whole body irradiation, which of the following is the most 
critical tissue to be shielded? 

a. Nerve ce I Is. 

b. Bone marrow. 

c . Adrena I . 

d. Muscles. 



MED447 2-14 



4. In adults, which of the following listed tissue types is the most 
rad iores istant? 

a. Muscle tissue. 

b. Bone marrow. 

c. Spermatocytes. 

d. Lymphoid. 



5. The type and severity of response in man to the acute radiation 
syndrome is especially dependent upon . 



6. List four c I assf i cat ions of the acute radiation syndrome 



7. About what is the range of the absorbed dose in the classification of 
no obvious disease ?" 



8. What classification of the acute radiation syndrome should you 
associate with the dose range of 200 to 800 rad? 



9. Which classification of the acute radiation syndrome represents the 
radiation injury for which treatment can do the most? 



MED447 2-15 



10. List four phases of the typical hematopoietic form of the radiation 
syndrome . 



11. One would expect to see the gastrointestinal form of the acute 

radiation syndrome when the acute dose is between and 

rad . 



12. Which of the following describes the treatment provided for a patient 
who has received a short-term, whole body exposure in excess of 800 rad? 

a. Therapeutic intervention. 

b . Pa I I i at i ve . 

c. Emergency. 

d . I ntens i ve . 



MED447 2-16 






SOLUTIONS TO EXERCISES, LESSON 2 
1 . d (para 2-2a) 

2. Japanese bomb casualties, Marshall Islands, laboratory and industrial 
accidents, and clinical radiotherapy. (para 2— 3a— d) 

3. b (para 2-4) 

4. a (para 2-4) 

5. Dose dependent. (para 2—5) 

6. No obvious disease; hematopoietic syndrome; gastrointestinal system; and 
CNS syndrome. (para 2—5) 

7. 0-100 rad (para 2-6) 

8. Hematopoietic syndrome (para 2—7) 

9. Hematopoietic syndrome (para 2—7) 

10. Prodromal; latent; bone marrow depression; and recovery. (para 2— 7a— d) 

1 1 . 800-3000 (para 2-8) 

12. b (para 2-8) 



MED447 2-17 



LESSON ASSIGNMENT SHEET 



LESSON 3 



--Comparative Effects of Nuclear Weapons; Residual 

Radiation Dose and Decay Calculations; and Management 
o f Mass Casua I 1 1 es . 



LESSON ASSIGNMENT 



■Paragraphs 3—1 — 3—18. Turn to Appendix A and study 
the nomograms in GR 76-332-100. 



MATERIALS REQUIRED 



--ABC— M1 radiac calculator. On the inside rear cover 
of tne subcourse is a printed simulated ABC— M1 radiac 
calculator. Cut out and assemble with pin, plotting 
needle, or thumbtack to solve the problems in this 
I esson . 



LESSON OBJECTIVES 



After completing this lesson, you should be able to: 

3—1. Estimate type and extent of casualty producing 
hazards of various yields of weapons. 

3—2. Calculate radiological dose and decay, using 
nomograms . 

3—3. Recognize ABC M— 1 Radiac calculator. 

3-4. Discuss categories of patients resulting from 
mass casualty situations. 



SUGGESTION 



--After completing the lesson assignment, complete the 
exercises at the end of this lesson. These exercises 
will help you to achieve the lesson objectives. 



MED447 



3-1 



LESSON 3 

COMPARATIVE EFFECTS OF NUCLEAR WEAPONS; RESIDUAL RADIATION 
DOSE AND DECAY CALCULATIONS; AND MANAGEMENT OF MASS CASUALTIES 



Section I. COMPARATIVE EFFECTS OF NUCLEAR WEAPONS 



3-1 . GENERAL 

With the exception of residual radiation, the effects of a nuclear 
weapon occur simultaneously. It is, therefore, appropriate to discuss the 
integrated or combined effects of nuclear weapons. At any given location from 
ground zero, one can determine the effects which are acting simultaneously to 
produce casualties. The various weapon effects may be compared using the 
casualty criteria below as a basis. No attempt has been made to evaluate the 
synergistic effect of two or more casua I ty— produc i ng mechanisms acting on a 
human target. 



EFFECT CRITERIA 


Blast 


3—5 ps i — For personnel in open, 50% probability 
of serious wounds from 1 Og glass fragments 
in 3 meters of travel (Impact velocity 55 
meters/second) . 

5 ps i — Threshold for eardrum rupture. 

5—10 ps i — 50% probability of lethality from dis- 
placement in 3 meters of travel (Impact 
velocity 8 meters/second). 

22 psi — Foxhole collapse (50% filling) 


Thermal Radiation 


4-10 cal/cm 2 — 2d° burns on exposed surfaces. 

7.5—20 cal/cm 2 — 50% probability of burns under 
summer un i form. 

10-26 cal/cm 2 — 50% probability of burns under 
wi nter un i form. 


Nuclear Radiation 


650 Rad — Nausea and vomiting within 2 hours (100%) 
3000 Rad — Nausea and vomiting within 5 min. (100%) 



Table 3-1. Casualty criteria for personnel exposed to prompt effects 
MED447 3-2 



3-2. GOVERNING EFFECT 

a. Table 3—1 illustrates the relative importance of the three initial 
effects in the production of casualties as a function of range for various 
explosion yields. The areas included within the radii which represent the 
2 hour (650 rad) and 5 min 100% (3,000 rad) sickness doses of ionizing radia- 
tion are relatively small and do not increase significantly as the weapon 
yield increases. Due to the manner in which ionizing radiation is degraded by 
distance, these radii of effects do not extend much beyond 2,500 meters (1.6 
miles) even for a one megaton weapon. A thousandfold increase in yield 
extends the range only by a factor of 3. The radii for blast effects do show 
a significant increase with weapon yield. For serious missile injuries (50 
percent probability) it can be seen that the range increases by a factor of 11 
and for displacement injuries (50 percent probability of lethality) by a 
factor of 15. The thermal effects radii portray the distances within which 
second degree burns will occur on exposed skin and under the uniform. Table 
3—2 demonstrates a dramatic increase in this range of 2° burns when the weapon 
yield is increased. For a one megaton weapon, 2° burns on exposed surfaces 
extend out to approximately 17,700 meters (11 miles) and include an area of 
about 984 square kilometers (379 square miles). For 2° burns under the winter 
uniform (50 percent probability), the range is 8,370 meters (5.2 miles). 



Casual ty cr i ter ia 


Yield 
1 KT 10 KT 100 KT 1 MT 


50% probability of serious 
wounds (glass fragments). 


(D 
740 


istance in 
1610 


meters) 
3860 


8530 


50% probability of lethality 
or displacement impact. 


450 


1130 


2900 


7080 


Foxhole collapse (50% filling). 


270 


580 


1260 


2730 


2° burns on exposed surfaces. 


805 


2415 


6440 


17,700 


2° burns — 50% probability 
under summer uniform. 


580 


1480 


3700 


9330 


2° burns — 50% probability 
under winter uniform. 


515 


1200 


3380 


8370 


650 Rads (Nausea and vomiting 
wi th in 2 hours) . 


840 


1290 


1770 


2570 


3000 Rads (Nausea and vomiting 
wi th i n 5 min). 


580 


970 


1530 


2090 



Table 3—2. Comparison of weapon effects (airbursts) 



MED447 



3-3 



b. With the lower yield weapons, nuciear radiation injuries, 
compounded bv mechanical injuries, will probably reoresent the predominant 
type of casualties. On the other hand, with the hiqner yield weapons, burns, 
wounds, and combinations thereof will represent the D r ecom ■ nant tyoes o* 
■njurv from the initial effects. in a fallout area, nuclear radiat on 
injuries wi : i constitute the ma in med ica orooiem. 

3-3. DETERMINATION OF EFFECTS BY USE OF NOMOGRAMS 



a. General. in o r de' to make 
e f *ec ts for the variety of weapon yiel 
+ound m Aopendix A, GR 76-332-100 may 
the r e a r e columns of data. There is, i 
the page, a distance or radius of dama 
on the right. As with any nomogram, t 
values to determine some unknown value 
airburst (p. A— 40) , 10 KT weapon, and 
would find that there would be 6.4 ps i 
brick apartment houses. This was obta 
straightedge, through the values 10 KT 
scale respectively, and reading the ef 
and severe damage. Particular caution 
to be sure that the right page is used 
f rom a low airburst, use the nomogram 
Similarly, one must be careful in usin 
that proper values are entered into th 
burst . 



the various calculations of weapon ' s 
ds and height of burst, tne nomograms 

oe used. in each of these nomograms 
n general, a V'eic column on tne left of 
ge co;umn in tne center, and some e'fect 
he procedure is to enter with two known 

For examp:e, if one takes a i ow 
determines the effect at 1000 meters, he 

overpressure with severe damage to 
i ned Py placing the ha i r I ine, or any 

and 1,000 meters on the left and center 
feet on the right— hand scale under ps i 

should be used with the blast nomogram 
That is, if one is calculating effect 
headed by Blast Damage Low Airburst . 
g the nomogram on thermal radiation so 
e center column for surface or a i r 



b. Distance Column of Nomogram. The distance c 
the nomogram may be headed radius of damage or distance 
damage" is a more general term for distance; that is, t 
defines a circle each part of which will, o f course, be 
ground zero, thereby defining all points of equal damag 
is in only one point on that circle; this is referred t 
ground zero. p or these calculations for low air and su 
distance to GZ wmI be the distance for entry nto all 
nomograms. The best way to gain proficiency in the use 
practice. For th>s pract'ee, a set of calculations of 
oeen orovided ana 'rom this a comparison of various par 
height of bu r st, distance of effects, and protection of 
der i ved . 



o I umn in the center of 
The term rad i us of 
he radius of damage 

equal distance from 
e. Interest generally 
o as the distance from 
rface burst, tne 
of tnese effects 

of any techn i que i s 
weapons' effects have 
ameters of yield, 

personnel can be 



c. Problem 1. Compare the effects of a 1 0-KT weapon at 1,000 meters 
distance. By using information found on pages A-39 , 40 , 41 , 42 , in Appendix A, GR 
76— 332-'00, you will * i nd the following: 





Blast ps i 


Therma 1 Ca 1 /cm i 


Rad Dose 


Low Air Burst 


6.2 


26 


1600 


Surface Burst 


5.0 


6 


1600 


Subsurface Burst 


Meg 


Neg 


Neg 



MED447 



3-4 



(NOTE: There is no nomogram for determining the effects of a subsurface 
burst, but we know that a major portion if not all (depending on tne deptn of 
the burst) of the initial effect wili be absorbed by the ground. We wii: 
expect Mtt'e or no atmospheric blast, heat, or radiation from a suosu rf ace 
burst. Keeo in mind, however, that a near surface subsurface burst, while 
be . ng minimal in prompt effects, will proauce a neavi'y contaminated area 
around ground zero as well as a significant fallout field downwind from tne 
burst. Considering not only that fallout is to be avoided but a so the 
magnitude of the b r ompt effects, it can be readily seen why the low airburst 
is the tactical weapon of choice. in every case it is superior or, at least, 
equal to the surface burst in prompt effects.) 

d. Problem 2. In this problem we will comoare tne effects of various 
yields of weaoons against unprotected personnel. For a low airburst, 
determine the distance to which each of the following effects will extend by 
actually finding the following information in Appendix A, 6R 76-332-100, pages 
A-39,40,41 ,and 42. 

Blast 6 ps i 2° burn 500 Rad 

.5 KT 

1 KT 

10 KT 

100 KT 

1 MT 



ChecK your findings with the findings given below. 
B I ast 6 ps i 



.5 KT 


380 m 


1 KT 


480 m 


10 KT 


1 ,000 m 


00 KT 


2,200 m 


1 MT 


4,600 m 



O 


burn 


500 Rad 




580 m 


700 m 




770 m 


800 m 


2 


100 m 


1 ,200 m 


5 


500 m 


1 ,700 m 


4 


500 m 


2,400 m 



in this comparison, it can be seen tnat radiation (rather than blast and 
secono degree burn) will cover the largest area with casualty producing 
effects in yields of 1 KT or less. In large yields the thermal effects will 
be the most extensive. 

e. Problem 3. In this problem, we will compare the effects of nuclear 
weapons against personnel in protected Dositions; i.e., foxholes. In this 
case use 2,000 rad in the open as a casualty producer in the foxhole, since 
one— fourth of the outside dose rate will penetrate into the foxhole (prompt 
effects). Ten percent of fallout will penetrate tne foxhole. For a low 
airburst, determine the distance to which each of the following effects will 
extend. Consider the personnel to be shielded in a standard 6' foxhole. 



MED447 3-5 



2000 rad in open 
Blast Thermal 500 rad in foxhole 



.5 KT 

1 KT 

10 KT 

100 KT 

1 MT 



Check your findings with the findings given below. 

2000 rad in open 
Blast Thermal 500 rad in foxnole 

.5 KT 200 m None 520 m 

1 KT 250 m None 610 m 

10 KT 530 m None 960 m 

100 KT 1 , 150 m None 1 ,340 m 

1 MT 2,500 m None 2,090 m 

The thermal effect is totally blocked by the foxhole. Both the blast and 
radiation are reduced by the protection of the foxhole; but when we compare 
the effects with the results of the previous problem against personnel in the 
open, we see that the blast casualty effect is reduced to about one— half its 
range in the open where radiation is reduced to a much lesser degree. The 
result is that against protected personnel, the radiation may be a serious 
hazard even in yields of over 100 KT . We would, therefore, expect to see a 
■ arqe number of radiation casualties in protected personnel close in to a 
relatively large nuclear burst where there might be limited or no other 
^juries present. Nuclear radiation is unquestionably tne most difficult of 
the three prompt effects to shield, and thermal radiation is by far the most 
r ead My d I ocked . 

f. Problem 4. If given a finite parameter of weapons effects and the 
y eid or distance from the burst, you can determine what other effects would 
be expected n the same location. For example, if you are given that skin 
reddening has occurred in your area and that rotted wood has been ignited and 
you are 2,000 meters from ground zero of a low airburst, you can then proceed 
to determine what other effects may be present. First, the yield must be 
determined bv entering the thermal nomogram with the known parameter of effect 
and Known distance. This will determine a yield of about 6.5 KT (Appendix A, 
GR 76-332-100, p. A-41). With the yield of 6.5 KT and distance of 2,000 
meters, now tne other effects can be determined. The blast effect would be 
'.8 ps i (Aopendix A, GR 76-332-100, p. A— 40) which would produce no serious 
casualties. There would also be a combined initial nuclear radiation dose 
(total dose) of 10 rad (Appendix, A GR 76-332-100, p. A-42) . This would also 
produce no serious casual' ?s. 

g. Problem 5. Gi> : a nuclear low airburst of relatively small yield 
was detonated approx imate i , 1,000 meters from your location. Wood frame 
structures were severely damaged; two aircraft parked nearby were not 
seriously damaged. What degree of burn would you expect to develop and what 

MED447 3-6 



radiation dose did your people probably receive? Using the observed effects 
and distance in the low airburst blast nomogram, the yield is determined to be 
2.5 KT (Appendix A, GR 76-332-100, p. A-40) . This would result in 5.6 cal/cm2 
(p. A— 41) and 350 rad total dose (p. A— 42) . The thermal would not produce any 
significant casualties, but the radiation dose would very definitely produce 
serious problems — probably in about 3 weeks when severe anemia would be 
present. This unit would be a loss at that time. 

3-4. CASUALTY ESTIMATION 

Having reviewed the relative effects of different weapons under a 
variety of sets of parameters, we can now turn to casualty estimation. In 
order to estimate the type of casualty to be expected, we must first determine 
the radius of damage for the casual ty—produc ing effect for a particular weapon 
of interest. If the unit in question is found to be within that distance we 
can expect to see the particular type of damage or injury. For example, 
members of a unit located 500 meters from a 1 KT burst would have at least 2o 
burns on exposed skin and would receive a serious dose of radiation, since 
they are well within the range of these effects. They would receive only 
moderate blast injuries because they are beyond the range of severe damage or 
blast effect in the open (Appendix A, GR 76-332-100, p. A-40). 

3-5. SUMMARY OF EFFECTS 

a. The type of burst will affect the casualty production by altering 
the range of the effect in the air. Surface bursts have somewhat less effect 
than airbursts, and subsurface bursts have considerably reduced effects or 
perhaps no atmospheric effect at all. 

b. The disposition of troops in protected positions will affect the 
casualty picture. In general, it will markedly reduce the number of injuries 
at any given distance. The amount of reduction will be different, however, 
for each of three effects. The thermal effect will be totally eliminated at 
any reasonable distance of interest. The blast effect will be reduced to 
approximately half the radius of damage for personnel without protection. The 
radiation is the most difficult to shield and is reduced to a lesser degree 
than the blast. We would, therefore, know that personnel in foxholes or 
underground shelters would not have thermal injuries and, if located 
relatively close in to a nuclear burst, might have ionizing radiation injury 
alone or a combination of radiation and blast injuries. 

c. In general, it can be said that for unprotected troops, weapons of 
1 KT or less will have initial ionizing radiation as their greatest casualty- 
producing effect. Under the same condition, it can be expected that thermal 
injury will be the most extensive for large— yield weapons, particularly up in 
the megaton range. With large— yield nuclear weapons, fire starting capability 
and flash burns will undoubtedly be the greatest hazard. 

d. Estimation of the number of casualties may be quite difficult; 
however, certain facts can help us in making an estimated determination of 
numbers. Certainly a unit beyond the radius of damage for any injuring effect 
would have no casualties. Equally certain, any unit located right in the 

MED447 3-7 



ground zero area of a burst will have a high percentage of lethal casualties, 
and relatively few hopeful patients. The difficult area for estimation of 
numbers or percentage of a unit injured I ies in the area of units that are in 
the margins of the damage range. We can certainly say, though, that a large 
Dortion of a unit in the open located at a distance where 3o burns and Durns 
through clothing occur will have thermal injuries. We can also be cautious in 
our management of bu^ns and blast injuries of troops exposed to a relatively 
small yield weapon, knowing full well that if they were close enough to get 
these injuries they must certainly have all received some serious dose of 
radiation. A large degree of judgment and educated guesswork wil nave to go 
into tne estimation of number of casualties until an expedience factor can 
iend fact to this area of conjecture. 

e. At this po'nt, we have no method currently accepted for field use 
for the estimat'on of nuclear Dattle casualties. With this understanding of 
the comparative effects and relative range of the effects, however, you should 
be able to make some reasonable estimate as to tne type and perhaps even 
numpers of casualties you might expect from a given weapon at a given 
d i stance . 



Section II. RESIDUAL RADIATION DOSE AND DECAY CALCULATIONS 



3-6. INTRODUCTION 

When it aopears I ikely that we may nave to operate in and around a 
fallout area, it becomes necessary to make some estimates of the radiological 
decay and doss ; b • e dose in this area. There are several methods which can be 
used to rnake dose and decay calculations, and many decisions may very well be 
based on these calculations. The radiological contamination in fallout for 
the most part is a combination of approximately two hundred radioisotopes 
o r oduced by the fission reaction; we refer to these radioisotopes as fission 
oroducts. Radioisotopes are unstable isotopes and in order to reach 
stab'Nty, they release energy. The result is ionizing radiation such as 
gamma rays o r a'o^a and beta particles. Rad i o ■ sotopes have a ha. f— life; this 
means t u at as the radiation is emitted, a percentage of the isotope becomes 
more stable. Th>s Drocess is referred to as decay. The radioisotope as it 
••e'eases energy decays to a stable state. The ha if— life is tne time it takes 
* r one-ha l r ■* the isotope to decay. The sigr ficance of this process is 
that ores fai 'out s complete there is a continuous decrease in the dese rate; 
init'ally this decease is cu i te rap:- but a f ter two days it slows down 
cons de^ab y . 

3-7. METHODS USED IN CALCULATING DOSES AND DOSE RATES 

There are three methods that can be used to calculate dose rates and 
tota' doses. Use of the dose rate and totai dose nomograms is the most 
accurate methoc, but it regu'res materials which may not be readily available. 
A second method is the ABC - MI RAD I AC calculator which is commonly referred to 
as the "whiz wheel." This method, while not as accurate as the nomogram, is 
convenient because the calculator can fit into the pocket of the uniform. The 

MED447 3_ 8 



last method for calculating dose rates or total doses is through the 
application of various "rules of thumb." This is the least accurate method, 
but it does not require any additional materials in application. 

3-8 . NOMOGRAMS 

One important fact to clear up here is that none of these methods can 
be used until the peak dose rate has occurred. Turn to page A— 12 in Appendix 
A, GR 76—332—100. The left side of this nomogram has a column heading of Rt. 
Rt is the dose rate at any time other than H + 1. The middle column (index) 
represents time of the dose rate (Rt) and accounts for standard decay rates. 
The column on the right (R1) is the dose rate at H + 1. This figure is 
"normalized" dose rate and may not reflect the actual H + 1 dose rate, but is 
used for mathematical convenience in the nomograms. This nomogram can be used 
then to determine past, present, and future dose rates once the peak has 
occurred. For example, if we know that at H + 2 the dose rate was 200 
rad/hour (the peak dose rate has occurred) , what will be the dose rate at H + 
3? We first must determine what the R1 dose rate is. Place your hairline or 
ruler on 200 in the Rt column, and on the two in the index column. You should 
be able to read approximately 450 rad/hr in the R1 column; this is the 
normalized dose rate at H + 1. Since we want the dose rate at H + 3, keep the 
hairline on 450 in the R1 column and rotate the hairline so that it intersects 
the 3 in the index column. The answer is found in the Rt column and should be 
approximately 120 rad/hr. Page A— 10 has the nomogram that is used to 
determine doses. Although it will not be demonstrated here, two comments are 
appropriate. Whenever this nomogram is used, you must always use R1 dose 
rate. Note the middle index line, this line is for reference only; therefore, 
in order to use this nomogram you must have values for three of the columns. 
Given these three values you can determine the fourth unknown value. 

3-9. ABC-MI RAD I AC CALCULATOR 

a. Introduction. The ABC— Ml radiac calculator provides a rapid method 
of calculating radiation hazards caused by radioactive fallout from a nuclear 
burst. The following calculations can be made using data from radiological 
survey reports and other sources: 

(1) Decay of radioactive fallout. 

(2) Normalizing survey data. 

(3) Dose absorbed by personnel exposed to radioactive fallout. 

(4) Exit time and length of stay. 

b. Definitions. 

(1) Decay of radioactive fallout. Decay of radioactive fallout is 
the decrease of radioactivity with the passage of time. 



MED447 3-9 



(2) Dose . Dose is the total number of rad which an individual 
will absorb during the time (exit time minus entry time) he is exposed to 
rad ioact i ve fall out. 

(3) Rad . A rad is a unit of absorbed dose. 

(4) Dose rate. The dose rate is the number of rad per hour to 
which personnel will be exposed. 

(5) Entry time. Entry time is the actual or planned time 
personnel enter an area of radioactive fallout. It is expressed as the number 
of hours elapsed from time of burst (H) . 

(6) Exit time. Exit time is the actual or planned time personnel 
leave an area of radioactive fallout. It is expressed as the hours elapsed 
from time of burst (H). 

(7) Normalization of survey data. Normalization of survey data is 
the process of converting the dose rate obtained from survey at a known time 
to the dose rate 1 hour after a nuclear burst (H + 1). 

(8) Transmission factors. Transmission factors are fractional 
amounts of radiation which will be transmitted through various types of 
shelters. The dose or dose rate to which unprotected personnel would be 
exposed is multiplied by the appropriate transmission factor to obtain the 
dose or dose rate for personnel protected by a specific shelter. 

inside dose/outside dose = (i.e., 50/100 = 0.5, TF = 0.5) 

c. Description. The ABC-MI radiac calculator (fig. 3—1) consists of 
three opaque white I ami nated pi ast ic disks — an inner disk,(y, an intermediate 
disk,^), and an outer disk,@ — mounted concentrically by means of an 
a I urn i num r i vet . 

(1) Inner disk. The inner disk is 1 15/16 inches in diameter. An 
ENTRY-EXIT TIME AFTER BURST logarithmic scale divided clockwise into minutes, 
hours, days, and weeks is imprinted in black on the outer edge of the disk. 
The HOURS and WEEKS portions of the scale are imprinted on a yellow 
background. That portion of the scale that extends beyond 20 weeks overlays 
the minutes portion of the scale to halfway between the 9 and 10 MINUTES 
positions, where the symbol for infinity (°°) marks the end of the scale. 

(2) Intermed iate d isk. The intermediate disk is 3 7/8 inches in 
diameter. A logarithmic scale divided counterclockwise into minutes, hours, 
days, and weeks is imprinted in black on the outer edge of the disk. The 1 HR 
position (H + 1) is imprinted in red. A TIME OF ENTRY index line, (J), is 
imprinted on the intermediate disk. The index line is used for alining the 
inner disk with reference to the intermediate disk. Red and black bands on 
the intermediate disk form a set of red, white, and black guide bands, (b) , 
from the scale on the inner disk to the scale on the intermediate disk. 



MED447 3-10 



© 



© 



\0,000 D °Sf 

,00° , V .._ JAOS 
















Figure 3—1. ABC-M1 radiac calculator. 

(3) Outer disk. The outer disk is 4 1/2 inches in diameter. A 
logarithmic scale divided clockwise from 0.1 to 10,000 is imprinted in black 
on the outer edge of the disk. The scale serves to indicate both a dose (in 
rads) and a dose rate (DOSE-RATE RAD/HOUR) . 

(4) I nstruct ions . Condensed instructions for use of the 
calculator to obtain the dose rate and the total dose are printed on the back 
of the calculator. 

(5) Transmission factors. The transmission factors that are 
printed on the back of the calculator match the transmission factors for the 
various type shelters which are shown in the Appendix A, GR 76—332—100, page 
A-8. 

d. Solving Problems. Examples of the types of problems that can be 
solved with the ABC-MI radiac calculator are explained and illustrated below. 



MED447 



(1 ) Decay of radioactive fallout (fig. 3-2) 

3-11 



(a) Problem. The dose rate reported by a survey team at 

2 1/2 hours after burst (H + 2 1/2 hours) was 50 rad/hr. What will the dose 
rate be at H + 5 hours? When will the dose rate be 2 rad/hr? When will the 
dose rate be 1 rad/hr? 

(b) Solution. Align 50 rad/hr on the DOSE-RATE RAD/HOUR 
scale with 2.5 hours on the time scale on the edge of the intermediate disk, 

(?) . Read the dose rate on the DOSE-RATE RAD/HOUR scale that aligns with 5 
hours (5 hr) on the time scale on the edge of the intermediate disk. The 
correct answer is 22 rad/hr at H + 5 hours, @. Read the time on the scale on 
the edge of the intermediate disk that aligns with 2 rad/hr on the DOSE— RATE 
RAD/HOUR scale. The correct value is H + 1.5 days,®, for a dose rate of 2 
rad/hr. Read the time on the scale on the edge of the intermediate disk that 
aligns with 1 rad/hr on the DOSE-RATE RAD/HOUR scale. The correct value is H 
+ 2.75 days, (^ , for a dose of 1 rad/hr. 




© 



Figure 3-2. Decay of radioactive fallout. 

(2) Normalizing survey data (fig. 3-3). 

(a) Problem. The following survey readings were reported 
from units in a fallout area. Normalize the readings to 1 hour after the 
burst (H + 1) . 



MED447 



3-12 






Unit 



T ime 



Reported dose rate 



Co A 
Co B 
Co C 



H + 2 
H + 3 
H + 4 



25 rad/hr 
10 rad/hr 
15 rad/hr 



(b) Solution. To normalize Co A's reported dose rate, align 
2 hr on the time scale on the edge of the intermediate disk with 25 rad/hr on 
the DOSE-RATE RAD/HOUR scale,©. Hold this setting. Read the dose rate on 
the DOSE-RATE RAD/HOUR scale that aligns with 1 hr on the time scale on the 
edge of the intermediate disk. The correct value is 58 rad/hr, (2). Follow 
the same procedure with the other reported dose rates. Correct normalized 
dose rates are tabulated on the following page. 



Unit 



T ime 



Co A 


H + 2 


Co B 


H + 3 


Co C 


H + 4 



Reported dose rate 

25 rad/hr 
10 rad/hr 
15 rad/hr 



H + 1 dose rate 

58 rad/hr 

38 rad/hr 

80 rad/hr 




© 



Figure 3—3. Normalizing survey data. 

(3) Dose absorbed by personnel exposed to radioactive fallout 
(fig. 3—4 ) . The following problem assumes no shielding for personnel exposed 
to fal I out. 



MED447 



3-13 



(a) Problem. The mission of a unit requires that personnel 
enter a fallout area 5 hours after a nuclear burst and remain in the area for 

7 hours. A dose rate of 30 rad/hr was present in the area at H + 1 hour. What 
is the dose these personnel would receive? 

(b) Solution. Align 30 rad/hr on the DOSE-RATE RAD/HOUR 
scale with 1 hr on the time scale on the edge of the intermediate disk.Q). 
Hold this setting. Align 5 hours on the ENTRY-EXIT TIME AFTER BURST scale on 
the inner disk with the TIME OF ENTRY INDEX line on the intermediate disk,(|). 
Hold this setting. Locate 12 hours,®, on the ENTRY-EXIT TIME AFTER BURST 
scale. (This value represents H + 5 hours plus the 7 hours that personnel must 
remain in the fallout area.) Note the position of the 12— hour line in 
relation to the white guide band on the intermediate disk. Follow the white 
guide band outward to the outer disk and read the dose on the DOSE RADS scale 
on the outer disk. The correct value is 18 rads,(4), which is the same 
relative position on the intermediate disk with respect to the white guide 
band as the 12— hour line on the inner disk. 




MED447 



Figure 3-4. Dose absorbed by personnel 

3-14 



(4) Dose absorbed by personnel in shelters. 

(a) Problem. If personnel in unit (3) above enter the 
fallout area in an APC, what is the dose that personnel will receive? 

(b) Solution. The transmission factor for an APC is 0.3. 

The dose received by unshielding personnel in (3) above was 18 rad. Total dose 
inside the APC, therefore, would be 0.3 times 18 or 5.4 rad. 

(5) Exit time or length of stay. By reversing the order of the 
procedure used above, exit time and length of stay in a fallout area can be 
calculated from survey data when a permissible dose is known. 

(a) Problem. How long can a unit remain in a fallout area 
and not exceed a dose of 18 rad if the dose rate was 30 rad/hr at H + 1 and 
the unit is scheduled to enter the area at H + 5? 

(b) Solution. Align 30 rad/hr on the DOSE-RATE RAD/HOUR 
scale with 1 hr on the time scale on the intermediate disk. Hold this setting 
and align 5 hours on the ENTRY-EXIT TIME AFTER BURST scale with the TIME OF 
ENTRY INDEX line on the intermediate disk. Hold this setting. Locate 18 rad 
on the DOSE RADS scale on the outer disk. Note the position of 18 rad in 
relation to the white guide band on the intermediate disk. Follow the white 
guide band inward and read the time on the ENTRY-EXIT TIME AFTER BURST scale 
that corresponds to the same position on the white guide band as the 18 rad 
line on the DOSE RAD scale. The reading on the ENTRY-EXIT TIME AFTER BURST 
scale is 12 hours. At this time H + 12 hours, the unit must leave the area. 
Since the unit entered the area at H + 5 and must leave the area at H + 12, 
the allowable length of stay is 7 hours. 

(6) Earliest allowable entry time. 

(a) Problem. If a reading of 1,000 rad/hr is observed at H + 
15 minutes, when can unprotected personnel enter the area and remain for a 
period of 3 days and not exceed an absorbed dose of 200 rad? 

(b) Solution. Align 1,000 rad on the DOSE-RATE RAD/HOUR 
scale with 15 minutes on the time scale on the intermediate disk. Hold this 
setting. Manipulate the ENTRY-EXIT TIME AFTER BURST scale until 200 rad on 
this scale, as indicated by the guide band, aligns with a time in excess of 3 
days. Note the time on the ENTRY-EXIT TIME AFTER BURST scale, which is now 
aligned with the TIME OF ENTRY INDEX line on the intermediate disk. By 
careful manipulation of the ENTRY-EXIT TIME AFTER BURST scale, it can be 
determined that troops can enter the area at about H + 11 hours and leave 3 
days thereafter and not exceed an absorbed dose of about 200 rad. 

3-10. "RULES OF THUMB" 

These rules are the least accurate method, but in the absence of any 
calculation materials they can be useful. 



MED447 3-15 



a. The "7—10" rule states that for every seven— fold increase in time, 
there is a ten-fold decrease in dose rate. If the dose rate at H + 1 is 1,000 
rad/hr, the dose rate H + 7 will be 100 rad/hr. If the dose rate at H + 4 is 
500 rad/hr, what was the dose rate at H + 28? There is one seven-fold 
increase so the dose rate would be 50 rad/hr. 

b. The second rule is called the "double— the— t ime" rule. When time is 
doubled, the new dose rate may be found by dividing the old rate by 2 and 
subtracting 10'/. of the result. If the dose rate at H + 1 is 1,000 rad/hr 
what wi I I the dose rate be at H + 2? 

1 .000 = 500 x10% =50 
2 

500 - 50 = 450 rad/hr at H + 2 

c. The last rule is called the "FIT— forever rule." This rule deals 
with the dose only. The rule is described by the formula D = F x I x T where: 

D = the dose which would be received by an individual who stays 
forever at a particular location in fallout. 

F = 5, a constant for all problems. 

I = the intensity or dose rate at that location at the time he 
reached that location and began his exposure. 

T = the time in hours after the burst that he began his 
exposure. 

If a man reached a particular spot in a fallout field at H + 4 and the dose 
rate was 20 rad/hr, what dose would he receive if he stayed indefinitely? 

D = F x I x T 

D = 5 x 20 x 4 

D = 400 rad total dose 

d. So you can see, we do have some ways to calculate or estimate 
future dose rates and doses due to fallout radiation. Fallout contamination 
is a hazard, not an obstacle. Like any other hazard we can reduce its effects 
if we know how to handle it. This information will be valuable to you if you 
are faced with the problem of working in or moving through a fallout 
contaminated area. 



MED447 3-16 



3-11. RESIDUAL RADIATION PROBLEMS AND SOLUTIONS 
a. Nomograms. 

(1) Given: R1 = 50 rad/hr. 
Find: R2.5. 

Answer : 16 rad/hr (acceptable range 14-18 rad/hr). 

Solut ion: Use page A-12 in Appendix A, GR 76-332-100. Align 
the hairline at the 2.5 hour tickmark on the index 
scale. Pivot about the intersection on the index 
line (H + 2.5) to the 50-rad/hr point on the R1 
scale. Read the DR at H + 2.5 hours where the 
hairline intersects the Rt scale at 16 rad/hr. 

(2) Given: R1 = 80 rad/hr. 

F ind : The time in hours after the burst when the dose 
rate decays to 35 rad/hr. 

Answer : H + 2 hours (acceptable range H + 1.8 — H + 2.2 
hours) . 

Solution: Use page A-12 of Appendix A, GR 76-332-100. Align 
hairline at 80 rad/hr on the R1 scale and 35 
rad/hr on the Rt scale. Read the time corre- 
sponding to Rt on the index scale as H + 2 hours. 

(3) Given: R6 = 120 rad/hr. 

F ind: Dose rate at H + 30 hours. 

Answer : 16.5 rad/hr (acceptable range 15 - 18 rad/hr). 

Solution: Use page A-12 of Appendix A, GR 76-332-100. Align 
hairline to intersect the Rt scale at 120 rad/hr 
and the index scale at 6 hours. Read R1 as 
1,000 rad/hr. Rotate hairline to keep hairline at 
1,000 rad/hr on the R1 scale and to intersect the 
index at 30 hours. Read R30 = 19 rad/hr on the RT 
seal e. 

(4) Given: a. Entry time = H + 4 hours. 

b. Stay time = 4 hours. 

c. R1 = 100 rad/hr. 

d. No radiation protection 
F i nd : Total dose (D) . 

MED447 3-17 



Answer : 48 rad (acceptable range 44 — 52 rad) . 

Solution: Use page A-13 of Appendix A, GR 76-332-100. Lay 
hairline to intersect H + 4 hours on the entry 
time (Te) scale and 4 hours on the stay time 
(Ts) Scale. Note a point at about .495 on the 
index scale. Rotate the hairline around this 
point on the index scale to intersect 100 rad/hr 
on the dose rate (R1) scale. Read total dose as 
48 rad on the total dose (D) scale. 

(5) Given: a. Entry time = .9 hours. 

b. Stay time = 30 minutes (same as .5 hours on 
nomogram) . 

c. R1 = 60 rad/hr. 

d. No radiation protection. 
F i nd : Total dose from fallout. 

Answer : 26 rad (acceptable range 24 — 28 rad). 

Solution : Use page A-13 of Appendix A, GR 76-332-100. 
Procedure same as in 4 above. Rotate on index at 
about .43. 

Rules of Thumb. 

(1) Given: R3 = 200 rad/hr. 
Find: R21 . 

Answer : 20 rad/hr. 

So I ut ion: By observation it is apparent that the "7-10" rule 
applies, 21 being the product of 7 x 3. There is 
one sevenfold increase in time, hence one tenfold 
decrease in intensity. Therefore, 200 x 10% = 20 
rad/hr . 

(2) Given: R3 = 300 rad/hr. 
Find: R6. 

Answer : 135 rad/hr. 

So lut ion: It is apparent that 6 is twice 3. Therefore, we 
must use the "doubl e-the-t ime" rule. 300 E 2 = 
150. 10X of 150 is 15. 150 - 15 = 135 rad/hr. 



MED447 3-18 



(3) G i ven: a. Time of entry = H + 2. 

b. R2 -= 50 rad/hr. 

c. Stay time = infinity. 

F i nd : Total dose, unprotected. 

Answer : 500 rad. 

Sol ut ion: This problem requires use of the "F IT— forever " 

rule. FIT stands for Five x Intensity x Time of 
entry, and gives us a total dose for an infinite 
stay in the area of interest. F (5) is a constant. 
I, in this case, is 50 rad/hr. T is H + 2. 
Therefore, 5 x 50 x 2 = 500 rad total dose for an 
i nf i n i te stay. 

(4) Problem: At a particular location in a fallout area, the 

dose rate measured at H + 2 hours was found to be 
90 rad/hr. 

Requ irements: a. Using the "seven— ten" rule, what will the dose 

rate be at H + 14 hours? 

b. Using the "doub I e— the— t ime" rule, what will the 
dose rate be at H + 8 hours? 

c. Using the "FIT forever" rule, what would be the 
maximum dose to individuals who moved into this 
area at H + 2 hours? 

Answers: a. 90 rad/hr = 9 rad/hr. 
10 

b. 90 rad/hr = 45 rad/hr. 



45 rad/hr - 4.5 = 40.5 rad/hr 
40.5 rad/hr = 20.25 rad/hr. 
2 



20.25 rad/hr - 2.025 = 18.2 rad/hr = R8 
c. D = FIT = 5 x 90 x 2 = 900 rad. 



MED447 3-19 



Section III. MANAGEMENT OF MASS CASUALTIES 



3-12. INTRODUCTION 

a. In September 1961, President Kennedy made the statement, "Nuclear 
weapons and the possibility of nuclear war are facts of life we cannot ignore 
today." The facts about nuclear warfare are not pleasant, yet they need to be 
known to dispel some of the confusion, misconceptions, and misunderstandings 
that exist. If we are afraid to discuss these issues and to face up to the 
grim facts, we will certainly be afraid to meet the crisis if, and when, it 
comes. This section covers, in general, the effects of nuclear weapons in a 
mass casualty situation, benefits of shelter and warning, use of sorting 
stations and type of treatment, need for training and the training of 
nonmedical personnel, and stockpiling of equipment. 

b. The implementation of these considerations requires an 
understanding of the following: (1) the effects of nuclear weapons on people 
and property; (2) the benefits of protection in lessening the medical 
workload; (3) the exploitation of known and accepted mass casualty care 
policies to extend the best possible care to a large number of casualties; (4) 
the training and maximum use of al I health workers; (5) the stockpi I i ng of 
supplies and preplacement of medical facilities; (6) preventive and corrective 
measures to stabilize environmental health problems; (7) administrative 
support and control; and (8) an overall regional medical disaster plan that 
provides the framework within which each of the foregoing measures is 

accomp I ished . 

c. A mass casualty situation is one in which a sufficiently large 
number of casualties is generated relatively simultaneously so as to far 
outweigh our normal treatment capabilities, which are additionally lessened by 
the loss of medical personnel, goods, and facilities. The appearance of an 
organized medical effort is likely to be delayed for a period of time and a 
great disparity will exist between the extent of the problem and the medical 
means to solve it. This disparity exists in three main areas: (1) the 
magnitude of the casualty workload, (2) the need for trained personnel to 
provide care, and (3) the necessity for supplies and facilities to support 
casualty management. 

d. Obvious approaches to overcome this disparity are to: (1) use 
protection to lessen the casualty load; (2) train personnel in self— care 
procedures to contain the casualty problem until organized medical help is 
available; (3) train paramedical personnel and physicians to follow accepted 
mass casualty care principles of sorting, treatment, evacuation, and 
hospitalization in order to best cope with the medical workload; and (4) pre- 
position facilities and stockpile supplies so that medical care personnel have 
a place to work and something with which to work. 

e. Beyond the period of shelter and self— help, a logical approach to 
organized medical care is to prearrange all the medical facilities around each 
potential target city into a single regional casualty care system. In the 
military, regional medical organization is provided as part of an area damage 

MED447 3-20 



control plan. Provision is made to support the target zone with nonmedical 
rescue and del ivery, casualty sorting stations which provide sorting and 
emergency care, and nearby predes i gnated suppor t— f ac i I i t i es which have altered 
their configuration to suit mass casualty needs. Additional support is 
provided in depth on a regional basis by existing, intact hospitals. In 
civilian communities, the principles of this regional system may be applied by 
using multiple pre— pos i t i oned casualty collecting stations, nearby intact, 
expanded community hospitals and more distant supporting hospitals each 
aligned on every main road leading away from the target city and arranged to 
provide a step— wise chain of sorting, treatment, evacuation, and hospital- 
ization. This system provides the means for putting into practice all the 
known concepts and programs for mass casualty care and disaster medical 
p I ann i ng . 

3-13. PROTECTION AGAINST NUCLEAR WEAPONS 

Protection against the blast, thermal, and ionizing radiation effects 
of nuclear weapons is provided by three factors — shielding, distance, and time 
(SDT) . The more shielding put into a shelter, the better the protection 
afforded. The greater the distance from ground zero the less shelter needed 
for immediate survival. With the passage of time beyond weapon detonation, 
all the weapons effects become diminished, leaving one chief hazard — radio- 
active fallout. It, too, decays at a certain rate, making shelter protection 
relatively more effective as time passes. Medically speaking, all three 
shelter factors have the potential of lessening the casualty count. The more 
widespread that shelter usage becomes, the more manageable is the medical 
problem. The value of shelter, especially against the fallout hazard, seems 
unquest i oned . 

3-14. MOCK THERMONUCLEAR ATTACKS 

a. Study by United States Congress Joint Committee on Atomic Energy. 

(1) Studies of mock thermonuclear attacks have shown, 
interestingly enough, that in all probability, radioactive fallout might 
produce more casualties than the immediate bomb effects. One such 
unclassified study using 1446 megatons of weapon yield on 224 U.S. cities 
reveals that there would be about 70 mill ion victims — 50 mi I I ion dying and 20 
million left as surviving injured. it was estimated that in the surviving 

injured group only one— third of the casualties would be caused by the blast 
and thermal weapon effects while two— thirds would be produced by ionizing 
radiation from radioactive fallout. If the population had 30 minutes warning 
and appropriate shelter, then the number killed would be reduced to 14 million 
and the number of surviving injured reduced, theoretically, almost to zero. 
There obviously would still be surviving patients in such numbers as to be of 
grave concern, but the medical workload is reduced and is more manageable. 

(2) One way to relate the effect of protection on the casualty 
workload is to consider some interesting guesswork statistics regarding a 
theoretical pat i ent— phys i c i an ratio. Using figures from the same attack, with 
an unwarned and unprotected population, there are 10 million patients 
generated. It is estimated that 75 percent of existing hospitals would be 

MED447 3-21 



lost in the same attack, and assuming that 75 percent of our 240,000 
physicians are lost also, there would be only 60,000 physicians left to take 
care of 20 million patients. This represents 333 patients per physician. If 
the shelter program were 90 percent effective, there would be only nine 
casualties per physician, assuming that physicians are protected the same as 
others. Although this latter figure represents a sizeable reduction in the 
pat i ent— phys i c i an disparity, in absolute numbers there are still two million 
patients requiring care. This is a larger casualty load than ever faced in 
all medical experience. We must still prepare to manage the casualty workload 
by mass casualty methods and must rearrange our medical planning and action 
along these lines. Shelter does not eliminate the medical problem entirely, 
but only makes it more manageable. 

b. Or lando, Flor ida. 

(1) Orlando, Florida, is 48 square miles in area and has a 
population of 162,000. If a weapon is detonated in the air on a clear day 
over the center of the unwarned and unprotected city, the following approxi- 
mate medical workload results: 52,000 dead, 45,000 injured, and 65,000 unin- 
jured, plus the loss of about 75 percent of existing hospital beds and medical 
personnel. If we assume that all 500 physicians in Orlando survive and there 
are 25 experienced surgeons available to do sorting, then at a rate of 50 
casualties sorted per hour per team, sorting alone requires 1 1/2 days. For 
this reason sorting and emergency treatment must proceed concurrently with the 
physician confining his activities to sorting and overall supervision, while 
other health workers provide treatment according to the priorities established 
for the minimal, immediate, delayed, and expectant groups. 

(2) Let us further suppose that all 500 physicians in Orlando 
survive, work only in the operating room and have all the necessary supporting 
elements, but continue to perform laparotomies, craniotomies, thoracotomies, 
etc., according to customary standards. It would then require over six days 
of uninterrupted work to complete the surgical workload. Adding 1 1/2 days 
for sorting means that some casualties would receive no surgical care 
whatsoever for many days, or even a week. Even with unreasonable concessions 
made, Orlando cannot handle the casualty workload alone, nor can it follow 
customary standards of care. The casualty problem becomes manageable only 
when Orlando employs proper sorting techniques, utilizes the mass casualty 
treatment policies and procedures outlined before, and receives outside 
medical support. This outside support could be provided in the form of a 
regional medical disaster plan which brings every possible medical resource of 
an entire area around Orlando to bear on the casualty workload. The exact 
pattern in the 45,000 injured is extremely difficult to predict, but a crude 
guess would be that there would be one— third burns, one-th i rd trauma, and 

one— third of the cases with both burns and trauma, plus injury from prompt 
ionizing radiation in various combinations with other injuries. However, for 
the purposes of early sorting, radiation sickness is not considered, since 
accurate detection of most cases is not medically feasible at this time. 

(3) A look at just one of these gross injury types — burns — 
illustrates the problem that Orlando faces in providing medical care. About 
two-thirds of the 45,000 casualties would have burns. Of these 30,000 burned 

MED447 3-22 



patients, the approximate distribution by extent of burns is: 5 to 20 percent 
of body burned — 50 percent or 15,000 patients; 20 to 40 percent of body 
burned — 10 percent or 3,000 patients. The patients with burns of less than 20 
percent of the body will take care of themselves for the most part. The 
mortality will not be raised appreciably by this approach. The 10 percent of 
patients with burns of over 40 percent of the body surface have a high 
mortality rate even with ideal treatment and will be made as comfortable as 
possible. Those casualties with 20 to 40 percent body surface burns present a 
major problem since the mortality is closely related to the efficacy of 
treatment. Most of these patients will be treated by the exposure method. 
During initial treatment they have a high priority to receive intravenous 
fluids and antibiotics. Beyond the first few days, oral fluid and electrolyte 
replacement should be possible. Ideal treatment for these burn groups would 
require inordinate amounts of blood, bandages, fluids, and drugs far beyond 
the medical supply means of Orlando. 

(4) Let us suppose Orlando, beyond the sorting period, attempts to 
treat these 45,000 casualties by customary standards, in which case every 
casualty receives full resuscitation and necessary definitive surgery within 
24 hours. An immediate requirement exists for 30,000 hospital beds. Orlando 
had less than one— tenth this number originally and now 75 percent of these are 
gone. If we suppose that the beds do exist, then of the 30,000 hospitalized 
patients, approximately 20,000 need surgery. Assuming that a surgical team 
does 10.5 cases per 24 hours, as determined by time studies from the Korean 
War, then over 1,900 surgical teams are required, plus necessary supporting 
personnel, equipment, and operating rooms in order to complete the surgical 
task within one day. The hospitalization and surgical requirements alone 
preclude the possibility of providing care according to customary standards. 

3-15. MEDICAL SORTING 

a. Sorting in Combat Situation. Sorting (triage) is defined as the 
procedure by which the sick and wounded are classified as to the type and 
urgency of the condition presented, so that they can be routed to the 
installation BEST suited for their care. It is a dynamic, continuous, 
systematized, yet flexible approach requiring the most mature professional 
judgment available. Sorting has been used successfully in the past by the 
military as the only logical means to: (1) initiate the handling of a large 
number of casua 1 1 i es; (2) ensure a max imum utilization of personnel, supplies, 
and facilities; (3) assure the least delay possible in evacuation and therapy; 
(4) restore needed manpower; (5) decrease morbidity and mortality to the 
lowest degree possible; and (6) give the highest priority for treatment to the 
ser i ous I y wounded . 

b. Sorting in Mass Casualty Situation. Sorting (triage) in a mass 
casualty situation is the procedure by which the sick and wounded are classi- 
fied according to the condition presented, but the highest priority is now 
given to lifesaving and group effectiveness procedures and the patients are 
now routed to any med ical installation. Now we must give a high priority to 
those requiring simple lifesaving measures, short definitive surgical proce- 
dures that resuscitate, and minor definitive treatment that restores the 
patient to an effective state. The goals are to save lives and restore group 

MED447 3-23 



effectiveness for the maximum number, within the available means. Sorting is 
not to be interpreted as a method of ascertaining whether or not casualties 
receive treatment at all. Wherever possible, all patients receive emergency 
and comfort care. Sorting does determine in what order treatment is given 
and, moreover, establishes a priority for the definitive care given 
subsequent I y . 

c. Person Doing the Sorting. The person doing the sorting should be 
an experienced physician, well— versed in trauma and disaster practices. He 
must not only be professionally competent but also should have knowledge where 
possible of the total extent of the casualty problem expected, availability of 
medical support, and many facets of the problem other than patient care. Any 
of these factors may affect the sorting and treatment techniques employed. 

The physician should not become involved in the performance of treatment 
procedures. His experience and judgment are needed to delegate treatment 
priorities. Other workers, especially paramedical personnel, will provide 
most of the treatment, so that sorting and treatment may proceed concurrently. 

d. The Sorting Team. Sorting is performed at every facility handling 
patients. However, initial sorting is performed adjacent to the disaster site 
by a sorting and emergency care team. In the military, a typical sorting team 
consists of a physician in charge, a dental officer as his assistant in charge 
of treatment, and between 12 and 15 medical specialists who provide emergency 
care. This team is dispatched from the nearest medical facility to the 
disaster area. Its mission is to provide early care for the injured according 
to the priorities outlined in paragraph e below, return the minimally injured 
to gainful work after treatment, and to evacuate those patients needing 
hospitalization. This team cannot become involved in the rescue and delivery 
of the injured to the sorting station. Nonmedical workers must accomplish 
this job, which again emphasizes the importance of teaching laymen proper 
methods for transporting patients. Sorting is continued at the receiving 
medical facility, but it now assumes a different aspect since many patients 
have been removed from the medical system by death or return to work. 
Priorities are now established for the order in which definitive care is 
given. The extent of the definitive procedure provided is determined by the 
mass casualty treatment policy for that facility. 

e. Categories of Sorting. For purposes of classifying patients to be 
sorted in mass casualty situations, the military services have adopted four 
categories, as described below. The American Medical Association 
classifications (priorities) are in parentheses. A rough estimate of the 
percentage of the total injured to be expected in each category is also shown. 

(1) Minimal category (priority I) 40 percent. Patients who may 
be returned to duty qualify for minimum treatment and include those who have 
small lacerations or contusions; closed fractures of small bones; or second- 
degree burns of less than 20 percent of the body but not involving 
incapacitating burns of face, hands, or feet. 

(2) Immediate category (priority II) 20 percent. Included as 
patients requiring immediate care are those with hemorrhage from an easily 
accessible site; rapidly correctible mechanical defects; severe crushing 

MED447 3-24 



wounds of the extremities and incomplete amputations; and open fractures of 
major bones. The patients in this group will be given the highest priority 
for surgical treatment because a relatively short procedure could save life or 
limb. More definitive surgery would be delayed to a later date. An increased 
rate of complications and permanent disability would have to be accepted. 

(3) Delayed category (priority III) — 20 percent. Persons whose 
surgical treatment can be delayed without immediate jeopardy to life include 
those with simple closed fractures of major bones; moderate lacerations 
without extensive bleeding; second— degree burns of 20 to 40 percent of the 
body surface; and noncritical central nervous system injuries. This group is 
composed of patients for whom a delay in treatment might lead to complications 
but whose lives would not be unduly jeopardized by delay. The amount of delay 
between wounding and surgery for this group depends on the total number of 
patients with higher priorities who need treatment and the medical facilities 
ava i I able. 

(4) Expectant category (priority IV) — 20 percent. Included in 
this category are patients whose treatment would be on an extended delayed 
basis. The patients include those with critical injuries of the central 
nervous system or respiratory system; penetrating abdominal wounds; severe 
multiple injuries; and severe burns of over 40 percent of the body surface. 
The treatment of this group of patients would consist of that resuscitation 
and emergency medical treatment which the available facilities, total 
supplies, and number of professional personnel permit. They would have the 
lowest priority for surgery because the operative procedures required would be 
time consuming and technically complicated, so that an operation on one of 
these patients would theoretically jeopardize the lives of several in other 
higher priority groups. The more rapidly patients in other treatment 
categories are moved, the sooner more definitive treatment could be started on 
the injured in this category. 

3-16. PHASES OF CASUALTY CARE 

a. For medical planning purposes, the time period after an attack is 
arranged into four phases: (1) Phase I (up to 3 days) — the period before 
organized medical help is available. Self— care and first aid constitute the 
bulk of casualty care; (2) Phase II (3 to 20 days) — casualty care is pro- 
vided chiefly by paramedical workers under the supervision of physicians 
according to an organized pl.an; (3) Phase III (20 to 60 days) — treatment 

pr i nc i pi es wi I I f ol I ow more customary I i nes except for cons iderat ions due to 
the size of the remaining casualty load. Presumably, there is little resupply 
of resources. The last is Phase IV (after 60 days) — resupply begins and 
essentially normal medical practice resumes. These phases are purely 
arbitrary insofar as the time division is concerned. Separate phases may 
exist concurrently or be prolonged by lack of personnel or equipment. 
Although predicted only upon a single attack, the concept is useful for medi- 
cal planning. Of prime concern is the casualty care and medical supply 
occurring in phases I and II, the period of greatest mass casualty emphasis. 

b. As recommended by the American Medical Association Commission, 
paramedical workers should be trained to perform certain patient care func— 

MED447 3-25 



tions, especially those of a lifesaving nature, ordinarily reserved for 
physicians in order to relieve the physician of duties that others can perform 
and to ensure the maximum possible use of all health resources. Patient care 
functions for this group are shown in Table 3—3. 

c. During phase II, nurses, veterinarians, dentists, and many other 
al I ied health workers wi I I play an important role in providing organized 
medical help according to plan. These workers must have prior training, legal 
permission, and proper supervision in order to do their best job. Patient 
care functions for this group are also shown in Table 3—3. 

3-17. EMERGENCY MEDICAL CARE 

a. The ability of lay citizens or soldiers to protect themselves, bind 
up their own wounds, care for families and friends, and deliver casualties to 
treatment facilities, largely determines the casualty workload faced later by 
organized medical support. The American Medical Association Commission 
recommended that "the general public receive training and become proficient in 
the application of first aid and self— aid procedures." Such training is now 
available in the medical se I f— he I p training programs for civilian laymen, the 
Air Force Buddy— Care Program under AF Pamphlet 160—2, and the Army's Training 
in First Aid, FM 21-11, 7 October I985. 

b. Although the above programs are not identical in scope, content, 
and teaching method, al I have the same purpose. The goal of the Army program 
is to teach the essentials of self— aid and emergency medical care to every 
soldier and officer not in the Army Medical Department. The following 
proficiencies are included. 

(1) Stop bleeding — pressure dressing, tourniquet as a last resort. 

(2) Airway management — initial measures, mouth— to-mouth resusci — 
tat ion . 

(3) Wound care — sterile and improvised dressings. 

(4) Prevent and treat shock. 

(5) Splinting fractures. 

(6) Emergency care of burns, head wounds, chemical injuries, etc. 

(7) Psychological first aid. 

(8) Transportation of wounded. 

c. Additionally, nurses, veterinarians, and dentists should know how 
to give simple anesthesia, and the dentists will sort and care for facial 
injuries. For the other disciplines, the list of functions is modified 
according to the medical skill level and past experience of that particular 
group. For example, enlisted personnel without patient care experience are 
required only to have the nonmedical proficiencies, plus training in basic 

MED447 3-26 



nursing (blood pressure, temperature, pulse, and respiration) and psycho- 
logical care . 

3-1 8 . SUMMARY 

"Business as usual" ceases quickly in a disaster. The use of normal 
standards of medical care will only increase the early casualty problem. The 
medical and allied health services must provide the best service possible for 
the greatest number, according to standards of care acceptable to the 
situation, and utilize all resources to the maximum. Teamwork is the key to 
success — teamwork established through planning and practice prior to disaster 



MED447 3-27 



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MED447 



3-28 



EXERCISES, LESSON 3 

REQUIREMENT. The following exercises are to be answered by marking the 
lettered response that best answers the questions; or by completing the 
incomplete statement; or by writing the answer in the space provided at the 
end of the question. 

After you have completed all the exercises, turn to "Solutions to 
Exercises" at the end of the lesson, and check your answers with the Academy 
solut ions. 

1. A low airburst of a 1 KT nuclear weapon has severely damaged a 
nearby frame house. What is the approximate number of pounds per square inch 
(psi) exerted at the house? 

a. Less than 1 . 

b. A I i tt le less than 2. 

c. A little more than 2. 

d. About 3. 

2. In problem 1 above, you estimate the radius of damage to be 
about meters. 

a. 725. 

b. 600. 

c. 575. 

d. 300. 

3. A 10 KT weapon has been detonated at a distance of 1100 meters 
from your protected position. From information you have received it appears 
to have been a surface burst. What results do you expect to find when it has 
been determined that it is safe for personnel to emerge from the protected 
position? Severe damage to: 

a. Parked aircraft. 

b. Oil storage tanks. 

c. Bunkers and underground structures. 

d. Al I of the above. 



MED447 3-29 



4. You have experienced second degree burns on your face and hands in a 

low air nuclear detonation which had a ground zero about 805 meters away from 

your exposed position. You estimate the yield of the weapon to be about 

KT. 

a. 0.1. 

b. 0.5. 



d. 5. 

5. If you are in a foxhole 1260 meters from ground zero of a nuclear 
detonation and the foxhole collapses, what would likely have been the yield of 
the weapon? 

a. 1 KT. 

b. 10 KT. 

c. 100 KT. 

d. 10 MT. 

6. Nausea and vomiting will likely occur within one hour in personnel 
who are within 580 meters or less from the airburst detonation of a 1 KT 
nuclear weapon. If another person has suffered these same effects in another 
nuclear explosion, at a distance of 1300 meters, what would likely be the 
yield of the second weapon? 

a. 1-0 KT. 

b. 100 KT. 

c. 1 MT. 

d. 10 MT. 

7. You have been asked to estimate the degree of thermal injury to the 
bare skin, produced by a 5 KT nuclear weapon (airburst), with a ground zero of 
1500 meters from your unit. You say it: 

a . I s th i rd degree . 

b. Is second degree. 

c . Is f i rst degree . 

d. Does not produce any thermal injury. 



MED447 3 _ 30 






8. If the burst in Exercise 7 had been a surface burst, the calories per 
centimeter squared (cal/cm2) would have been: 

a. 8. 

b. 6. 

c. 3.2. 

d. 1.5. 

9. Which of the following personnel should per f orm med i ca I sorting? 

a. Any medical or paramedical personnel. 

b. Only paramedical personnel. 

c. Medical Corps officers of mature professional judgment. 

d. Medical officers, dental officers, and nurses. 

10. What would be the logical approach to organized medical care of mass 
casualties for civilian communities? 

a. Prearrange all medical facilities around each potential target 
into a single regional casualty care system. 

b. Augment the military Area Damage Control Plan and rely on it in 
the case of mass casualties. 

c. Depend entirely upon the nearest military installation for 
organized medical care of the injured. 

11. Following the burst of a nuclear weapon, which of the following 
casualty types would you expect to find in the immediate treatment category? 

a. Closed fractures of major bones. 

b. Noncritical burns over 20—40 percent of the body. 

c. Critical injuries to the central nervous system. 

d. Open fractures of major bones. 



MED447 3-31 



12. In a mass casualty situation, about what percent of all casualties is 
expected to need only minimal treatment? 

a. 80. 

b. 40. 

c. 20. 

d. 10. 

13. In a mass casualty situation, which of the following categories would 
have the lowest priority for surgery? 

a. Immediate. 

b. Expectant. 

c. Delayed. 

d . M i n ima I . 

14. The time period after a nuclear attack is divided into four phases 
for medical planning purposes. What kind of help would you expect in phase II? 

a. None. 

b. Self— care and first aid. 

c. Paramedical workers under the supervision of physicians. 

d. Essentially normal medical practice. 

15. In the event of a nuclear detonation, trained medical personnel would 
be used in all of the following, EXCEPT ._ 

a . Med i ca I sor ting. 

b . First aid. 

c. Rescue operations. 

d. Treatment facilities. 

e. a and c above, 
f . b and c above . 



MED447 3-32 



16. List the three methods that can be used to calculate dose rates and 
total doses. 



17. If the dose rate at H + 1 is 500 rad/hr, what will be the dose rate 
at H + 2? 

a. 225. 

b. 200. 

c. 150. 

d. 75. 

18. The most accurate method for calculating dose rates and total doses 
is the . 



MED447 



3-33 



SOLUTIONS TO EXERCISES, LESSON 3 

1. d (Appendix A, page A-40) 

2. a (Appendix A, page A— 40) 

3. a (Appendix A, page A— 39) 

4. c (Appendix A, page A— 4 1 ) 

5. c (Appendix A, page A-39 or A— 40) 

6. b (Appendix A, page A-42) 

7. b (Appendix A, page A— 41) 

8. d (Appendix A, page A-41) 

9. c (para 3— 15c) 

10. a (para 3-12e) 

11. d (para 3-15e(2)) 

12. b (para 3-15e(D) 

13. b (para 3-15e(4) ) 

14. c (para 3-16a) 

15. f (para 3— 1 5d) 

16. Nomograms; ABC— M1 RADIAC Calculator; rules of thumb. (para 3—7! 

17. a (Appendix A, page A— 1 2 ) 

18. Nomograms (para 3—7) 



MED447 3-34 



LESSON ASSIGNMENT SHEET 



LESSON 4 

LESSON ASSIGNMENT 
MATERIALS REQUIRED 
LESSON OBJECTIVES 



SUGGESTION 



— Command Guidance on Irradiated Personnel and Nuclear 
Accidents and Incidents. 

— Paragraphs 4-1 — 4-12. 

— None. 

After completing this lesson, you should be able to: 

4—1. Identify various factors influencing 

incapacitation following exposure to radiation 
under combat conditions. 

4—2. Be able to provide an estimate of probable 

effects of certain radiation exposures to his 
troops in terms of gross physical effectiveness. 

4—3. List the hazards of a nuclear accident and 
necessary precautions. 

4—4. Describe current concepts of medical operations 
in a fallout to specific situations. 

— After completing the lesson assignment, complete 
the exercises at the end of this lesson. These 
exercises will help you to achieve the lesson 
object ives. 



MED447 



4-1 



LESSON 4 

COMMAND GUIDANCE ON IRRADIATED PERSONNEL AND 
NUCLEAR ACCIDENTS AND INCIDENTS 



Section I. COMMAND GUIDANCE ON IRRADIATED PERSONNEL 



4-1. INTRODUCTION 

The characteristic of nuclear weapons which is of greatest concern to 
the Army Medical Department is their tremendous capability for the production 
of casualties. We devote a great deal of time and effort to the handling of 
mass casualties. We also know that the Army Medical Department must be 
prepared to continue medical operations in support of both nuclear and 
conventional casualties despite the tremendous potential of nuclear weapons to 
damage and destroy everything from facilities to communications. These are 
tremendous challenges, and in our concern for these problems, we usually 
overlook another nuclear medical responsibility which is peculiarly military 
and is absolutely vital to the Army's combat support mission. This is our 
time— honored responsibility for advising the commander upon all matters 
pertaining to the health of the command. Ionizing radiation is of interest to 
a commander for one reason: because of its effect upon people. Commanders at 
every level look to their surgeons for advice on the effect of radiation 
exposure upon troops. To make proper decisions, a commander needs information 
on both the present and future health of his command. On the battlefield, 
health is affected by trauma and disease. Radiation sickness is a disease. 
The effect on present health of a command of a particular disease is merely a 
tabulation of the daily reports of subordinate units. To predict the effect 
of a given disease on the future health of a command requires a reliable 
military experience factor. There is no such factor for radiation sickness. 
Therefore, to comment intelligently and reliably, the staff surgeon must 
familiarize himself with the present state of our knowledge and examine the 
parameters, which influence his advice. But at this point we need to define 
some terms. 

4-2. DEFINITIONS 

a. Command Radiation Guidance. Advice of the staff surgeon on the 
effect and influence of predicted and actual radiation received by a command. 

b. Operational Exposure Guidance (OEG) . The maximum amount of nuclear 
radiation which the commander considers his unit may be permitted to receive 
while performing a particular mission or missions. The numerical value for 
this guide is established by battalion and higher levels only, and is based 
upon the unit radiation status and degree of risk criteria. 

MED447 4-2 



c. Acute Dose. The total dose accumulated in 24 hours. 

d. Protracted or Fractionated Dose. Total accumulated in time periods 
greater than 24 hours when delivered in increments. 

e. Reference Dose. The amount of penetrating whole body radiation 
which is related to certain early effects of radiation on personnel. Dose- 
effects relationships. 



4-3. 



EFFECTIVENESS 



a. Individual. A key word in a discussion of command radiation 
guidance is the word "effectiveness." An effective individual is, of course, 
one who is capable of carrying out an assigned task. Therefore, to be 
meaningful, effectiveness must be described in terms of the task to be 
performed. Generally, combat effectiveness has been described in terms of 
gross physical effectiveness, requirements for which might vary from over 90 
percent effectiveness required to carry on hand— to— hand combat to as little as 
10 percent effectiveness required to simply fire a weapon. Most studies and 
discussions of the relationship between radiation exposure and military 
effectiveness have been based primarily upon gross physical effectiveness. It 
should be obvious, however, that there are military tasks requiring other 
kinds of effectiveness: manual dexterity, high skill levels, judgment, 
decision making, etc. The effect of radiation upon this kind of effectiveness 
is not well understood, but it is the target of much intensive research 
today. Table 4—1 illustrates this relationship between radiation exposure and 
physical effectiveness. 



( 1 ) Fire a prep I aced weapon 1 0% 

(2) Operate radio communications 20% 

(3) Dr ive a vehicle 50% 

(4) A im a weapon 80% 

(5) Assau I t a pos i t i on 90% 

(6) Hand-to-hand combat 90+% 



Table 4—1. Physical effectiveness required to perform typical combat tasks. 

b. Unit Effectiveness. Military commanders are more interested in 
unit effectiveness than in individual effectiveness. A commander wants to 
know, for example, what will happen to a certain unit if new radiation 
exposures are received, or what will happen to another unit as a result of an 
acute radiation exposure just received. How many individuals must be 
noneffective in order to make a military unit noneffective? Certainly if 50 



MED447 



4-3 



percent of a unit is noneffective, the unit is noneffective. It is generally 
agreed that if one— third of a unit is incapacitated, the unit is non- 
effective. Who is noneffective in the unit might be as important as the mere 
percentage of noneffectives. For example, loss of the command element might 
render a combat unit ineffective, or loss of the surgeons in a surgical 
hospital makes the hospital noneffective as a surgical hospital. 



RADIATION DOSES RESULTING IN NONEFFECTIVENESS 

a. General. The command surgeon must try to tell his commander not 
only j_f his troops will be incapacitated, but, insofar as possible, when . 

The timing of ineffectiveness is particularly important to the commander. He 
must consider time in two ways: first, the time— phasing of the radiation 
exposure, and second, the course of the radiation illness. First, consider 
the timing of the exposure: was it an acute or prolonged exposure? 

b. Acute Doses. 

(1) Most dose— effects are for acute exposures, simply because more 
valid and reliable reference dose information is available for acute 
exposures. If we look at the dose— effects relationships for moderate acute 
exposures, we can see that the time— phasing of the incapacitation which 
results is important to the military commander. Those exposed even to lethal 
doses of a few thousand rad and below do not become ineffective at once, nor 
do they necessarily remain ineffective once they have lost effectiveness. In 
the hematopoietic form of the disease, first there is a delay in the onset of 
symptoms following the exposure. This delay period may be one of days, or it 
may last only a few minutes, depending largely upon the magnitude of the dose. 
After the delay period, there is a prodromal phase lasting 2—3 days. This is 
followed by a latent period of perhaps 2—3 weeks. The latent period may be 
much shorter for high doses, on the order of a thousand rad or more. On the 
other hand, for very low doses, the prodromal phase may be so mild that 
effectiveness continues right on through it. The final phase is the bone 
marrow depression phase, with onset about the third week after exposure. This 
phase is terminated in several months by death or recovery. Note the two 
periods of some degree of effectiveness in the above discussion. There is the 
delayed onset period of minutes to days, and the latent period of from nothing 
to 2 to 3 weeks. These periods are of considerable importance to the 
commander and to the surgeon who advises him. 

(2) If we look at very high acute exposures, those in the CNS 
range, we see yet another t ime— effect iveness picture. We must realize that, 
while we talk of the hematopoietic form of radiation sickness occurring 
following exposures from 200 to 800 rad, the gastrointestinal form from 800- 
3000 rad, and the central nervous system form from 3000 rad, in reality there 
is no sharp line of demarkation between these various forms of the sickness. 

(3) In any case, the t ime— effect iveness picture following 
exposures at these levels differs considerably from that which has been 
presented for more moderate acute exposures. For this reason, the biological 
effects of this type of exposure are probably receiving more attention right 

MED447 4-4 



now than any other type of radiation effect. A review of those studies 
conducted to date leads to the following conclusions: 

(a) Even at doses over 2,500 rad, survival is possible for 
several days with considerable effectiveness for much of the survival time. 

(b) Although there is wide variation between individuals, the 
higher the dose, the earlier the irreversible incapacitation. 

(c) Very high doses of radiation are required for incapaci- 
tation in minutes — doses on the order of 80,000 rad. 

(d) There is evidence of a phenomenon called early transient 
incapacitation (ETI). This incapacitation occurs 5—7 minutes after exposure 
and lasts 8-10 minutes. The degree of ETI depends upon the magnitude of the 
dose. 

(e) Vomiting occurs only in some of those exposed at this 
level. It is interesting and important to note that these studies demonstrate 
clearly, when vomiting does occur, that it, of itself, is not necessarily 

i ncapac i tat i ng . 

(4) Now let us look at several examples of the interrelationship 
between the surgeon's advice and the commander's decision in several tactical 
situations involving acute radiation exposures to troops. 

(a) In the first situation, troops are in a defensive 
position of underground bunkers and machine— gun positions. The tactical 
nuclear weapon is a low airburst whose GZ is several hundred feet from the 
defensive position. The troops have excellent protection against thermal and 
blast effects, but still receive a mixed gamma and neutron dose of about 
20,000 rad. Given a good estimation of the dose to troops, the surgeon can 
tell the commander that some troops will be ineffective in 5—10 minutes. 
Fifty percent of them will be ineffective at the end of the first hour after 
exposure. All of these troops will die within a time period from a few hours 
to a day or so following exposure, whether or not they receive medical 
treatment. Whether the military situation is routine or emergency, there is 
really no decision for the commander. The surgeon can tell him that the unit 
is gone. The commander will have to replace the unit as soon as possible 
probably from his reserves. From the surgeon's standpoint, there is really no 
medical decision to be made, either. Medical evacuation and treatment will 
probably have no effect upon the course of the sickness and no effect upon the 
eventual outcome. From the commander's point of view, the early realization 
that this unit has been eliminated is valuable information and his prompt 
action may well affect the outcome of the battle. 

(b) In a second tactical situation, the same troops in the 
same defensive situation are exposed to a tactical nuclear weapon burst with 
GZ several hundred meters away. In this case, blast and thermal effects are 
essentially nil, but troops receive an acute dose of initial radiation on the 
order of 800 rad. In this case the surgeon can tell the commander that all 
will eventually die, but most could fire their weapons for several hours; many 

MED447 4-5 



could fire for a day; some could fire for several days. Here the commander's 
decision depends upon whether this is a routine or emergency situation. A 
realization that a substantial portion of the forces can continue the defense 
for some hours and perhaps for a day or so, may be extremely important in an 
emergency situation. It is also important to the commander to know that 
prompt medical evacuation and treatment will probably not save any of these 
exposed personnel. In an emergency, the commander may have to order these 
troops to continue the defense. On the other hand, of course, if the military 
situation is not critical, those exposed should be medically evacuated as 
symptoms appear . 

(c) In the third tactical situation, troops are in foxholes, 
trenches, and tanks hundreds of meters from GZ . Troops are not affected by 
blast and thermal effects, but receive doses of radiation between 300 to 400 
rad. The surgeon tells the commander that some of these troops will become 
noneffective within 24 hours, while some may be able to continue fighting for 
a week or more. All would benefit from medical evacuat i on w i th i n 24 hours. 
AM, or nearly all, should recover with treatment, but those who continue 
fighting for more than a couple of hours will have a much poorer chance for 
survival. With treatment, all should return to duty in two months or so. The 
commander's decision here again depends upon whether the military situation is 
routine or emergency. If it is routine and the unit is not under pressure or 
attack, personnel should be evacuated as symptoms appear and evacuees should 
be replaced. In an emergency situation, troops can continue to fight, 
especially in a defensive action for several days. But the resulting stress 
and delay in treatment will certainly kill a substantial percentage of the 
irradiated troops. 

(5) To illustrate this last point, there is the historical example 
of. a Japanese Army battal ion at Hiroshima which is al I eged to have received a 
dose of 300 rad when the Hiroshima bomb detonated. The military commander 
be I leved the attack to be a part of a pre— invasion sof ten i ng— up, so he 
implemented his portion of an emergency defense plan. He ordered the 
battalion to make a forced march to defensive positions some 35 miles away. 
All of the troops in this battalion died within 60 days. With a dose of 300 
rad, all should have survived. It is important from a commander's viewpoint, 
however, to point out that if this had been a part of an invasion, that 
battalion, after reaching defensive positions, would have been able to carry 
on defensive combat for several days despite the fact that all were eventually 
to die. 

c. Prolonged Exposure. The prediction of effectiveness subsequent to 
acute radiation exposure is difficult at best, but it is simple when compared 
with the prediction of effectiveness resulting from prolonged or fractionated 
radiation exposures. Yet the prolonged exposures may be the most likely kind 
making the greatest demand upon the surgeon for advice to the commander. 
There are several reasons why this type of exposure is most likely for 
survivors of nuclear attacks. 

( 1 ) Factors limiting number of survivors. 



MED447 4-6 



(a) First, there are a number of factors which tend to limit 
the number of personnel with significant radiation exposures who survive 
nuclear attack. The nature of the initial radiation pattern surrounding a low 
air burst tactical weapon is such that doses are very high close-in to GZ. 
However, doses drop off very rapidly within a short distance at some radius 
from the GZ . For this reason, most exposed personnel will sustain either a 
very high lethal dose or a militarily insignificant dose of initial radiation. 
Only personnel within a very narrow ring or "doughnut" around ground zero will 
survive with a dose which still requires continuing concern for future 
effect i veness. 

(b) Another factor limiting the survival of those with 
significant acute radiation exposures is the fact that, for weapons larger 
than the tact ical— s ized weapons, blast and thermal effects tend to overwhelm 
radiation. Thus, personnel receiving significant but not lethal radiation 
exposures are likely to be killed by something other than radiation. 

(2) Factors tending to increase survivors. At the same time, 
there are some factors which tend to increase the number of military personnel 
receiving significant but nonlethal doses as prolonged radiation exposures. 
Most of these are related to local radiological fallout. Radiation is the 
only hazard in fallout. There is no associated heat or blast effect to kill 
those exposed. The area involved in fallout radiation is many times the area 
involved with initial radiation. It is likely that the serious fallout area 
will be 100 times as large as the initial radiation area from the same weapon. 
Therefore, many more troops could be expected to be involved with the fallout 
radiation. Finally, the radiation hazard of initial radiation lasts for only 
a minute, but that of local fallout continues for days, allowing a much 
greater period of time for individuals to encounter the radioactive area and 
sustain injury. 

d. Lack of Reference Dose Information for Prolonged Exposure. A 

serious handicap to the provision of guidance to the commander concerning 
these prolonged exposures is the lack of valid reference dose information upon 
which to base the advice. There are several reasons for this lack. Most 
human data comes from radiation accidents. Acute exposure accidents are 
conceivable and do occur, but it is difficult to see how an accident resulting 
in continuing and prolonged exposure could occur with all the controls and 
safeguards which govern all activities involving radiation today. It has been 
suggested that human exposures in radiation therapy might provide useful human 
effects data; however, those receiving radiation therapy are not well to begin 
with and the physiological results are usually questionable. Also, 
therapeutical exposures are usually partial body exposures and effects are 
quite different from those from whole body exposures. Animal research in the 
prolonged exposure area is not widespread. The Navy Radiological Defense 
Laboratory at San Francisco, which was recently closed, was doing more of this 
type of research than any other research facility. With this source of 
information gone, there is little to encourage others to work in the area. 
This type of study is expensive, t ime— consuming, and is not popular with 
researchers. 



MED447 4-7 



e. Recovery from Radiation Injury. 

(1) The ability of the human body to recover from radiation injury 
is obviously closely related to the effects of prolonged radiation exposures, 
and we are seriously deficient in what we know about recovery from radiation 
injury. A few years ago we could give precise answers to questions concerning 
radiation recovery, but we can no longer do so with any assurance. 
Paradoxically, the reason for our current inability to answer questions 
concerning recovery from radiation injury is that we know more about it than 
we did a few years ago. We no longer consider recovery from radiation injury 
to be exponential, nor does it seem to follow any simple mathematical course, 
so we have had to give up our practice of quantifying radiation recovery with 

t ime. 

(2) If we are to make some generalizations with respect to 
recovery from radiation injury, we can only say that recovery does take place 
with time, but the rate and degree of recovery at an early time after exposure 

is not known. We know that some residual radiation injury remains after 
maximum recovery has taken place. This tends to leave the individual at least 
slightly more vulnerable to future radiation exposures, but we don't really 
know how much more vulnerable. General ly, we no longer make any attempt to 
quantify recovery but simply consider it as a bonus until many weeks have 
passed after the exposure. 

(3) As a result of our lack of reference dose information for 
prolonged radiation exposures and our very limited knowledge of recovery from 
radiation injury, we can give the commander only a little general advice 
concerning these exposures. We can tell him that unit ineffectiveness can be 
avoided by spreading radiation exposures across longer time periods and among 
different groups of people, and we can tell him that giving a unit a week or 
two of rest from radiation exposure may prevent its loss. More specific 
guidance concerning prolonged radiation exposures is a more complex problem 
with which the surgeon must deal. 

(4) It should be noted that when we speak of resting a unit from 
radiation exposure, we do not refer to removing the unit from combat and 
sending it to a rear— area rest camp. A unit can be subject to radiation 
exposure in rear areas as well as forward areas. A unit can be radio- 
logically rested by locating it in or near excellent radiation shelter and by 
not committing it to missions involving possible radiation exposure for some 
per i od of t ime . 

4-5. TASKS INVOLVED IN THE DEVELOPMENT OF RADIATION GUIDANCE 

a. General. Regardless of the state of our knowledge of the effects 
of ionizing radiation upon humans, there are several tasks which we must be 
able to accomplish if we are to give a commander meaningful radiation 
guidance. In order to develop radiological guidance, we must be able to: 

(1) Determine the radiological status of the unit at a given time. 
MED447 4-8 



(2) Measure or predict with accuracy any new exposure to the unit. 

(3) Assess the effect of the new exposure on the unit. 



b. Problems Inherent in Accomplishing the Three Tasks. There are 
problems inherent in the accomplishment of each of these tasks. 

(1) In the first case, what we are trying to do is determine the 
radiological vulnerability of the unit, or its susceptibility to any new 
radiation exposure. In this respect we are seriously limited because of lack 
of valid information on reference doses for prolonged exposures. We are even 
more handicapped when considering the effect of mixed acute and prolonged 
exposures. The reference dose information we do have relates to whole body 
exposures. The fact that most field military exposures are likely to be 
partial body exposures of varying degrees of complexity further complicates 
our task. If we are to determine the exposure status of a unit at any given 
time, we must keep some sort of record of unit radiation exposure. Who should 
do this and how? There is an official Army system for keeping such exposure 
histories, but at best such a system is limited in validity by the fact that 
unit exposures are taken as the average of only two instrument readings. This 
average can vary considerably from the actual unit exposure experience. 

(2) If we are to accomplish the second task in development of 
command guidance, we must be able to predict or measure new radiation 
exposures. In predicting new exposures we are on very firm ground when 
dealing with exposures in completed local fallout fields. These exposures can 
be both predicted and measured with considerable accuracy. If exposures come 
through new fallout fields, not completed at the time of prediction, or 
through acute exposures to new detonations yet to be encountered, then we can 
make no valid prediction at all. I f we are to measure new exposures, we are 
on firm ground with one exception; we cannot, with radiac equipment currently 
available, measure the neutron component of initial radiation. Since this is 
a substantial portion of the dose, we cannot, in effect, measure initial 
radiation exposures at all. In short, we can accomplish the second task when 
dealing with fallout, but not with acute exposures to initial radiation. In 
the latter case, we can only make rough estimates. 

(3) The third task requires that we be able to assess the effect 
of the new radiation exposure superimposed upon the prior unit radiological 
vulnerability. To accomplish this task, we must be able to do the first two 
tasks we I I . As we have seen, there are some I imitations in our abi I i ty to 
accomplish the first two tasks effectively. We are further limited in our 
assessment of the result by our lack of prolonged exposure reference dose 
information. This puts us in the difficult position of being able to measure 
and predict fallout exposures with considerable accuracy but not being able to 
determine the meaning of those exposures in terms of unit effectiveness. It 
can be seen from this discussion, that in many instances, the development of 
command guidance for troops exposed to radiation is certainly not an exact 



MED447 4-9 



science. Nevertheless, given a few assumptions, the surgeon can offer the 
commander advice in broad general terms in most instances and some rather 
precise advice in certain situations. This is shown in Table 4-2. 



ACUTE DOSE 


PROBABLE EFFECTS 


100 rad or less in 24 hours 


No ineffectiveness. (No previous radiation.) 


100-200 rad in less than 24 hours 


Spectrum of response from to temporary 
illness assuming no previous radiation. No 
evacuation for temporary illness. 


Greater than 300 rad delivered in 
less than an hour 


90 percent vomiting in 6 hours. (If no 
vomiting within 6 hours, probably under 
300 rad.) 


500- 1000 rad in 24 hours 


50 percent require medical evacuation in 
less than 24 hours. All in medical channels 
after 24 hours. 


REPEATED DOSES 


PROBABLE EFFECTS 


25 rad in less than 24 hours 
at weekly intervals for 8 weeks 


No ineffectiveness. 


350-450 rad gradually over 
1 year 


Decreased radiation reserve. 
Decreased efficiency and increased, 
susceptibility to trauma and late effects . 



Table 4-2. Acute dose 



MED447 



4-10 



Rad iat ion 


Cumu 1 at i ve 


Allowable Single Mission Dose 

For Each Assigned Degree of Risk (RADs) 


Status 


Dose Received 


Category 


(RADs) 


RS-0 





Neg I ig i b I e: 50 
Moderate: 70 
Emergency: 150 


RS-1 


0-70 
Avg. 40 rad 


Negl igible: 10 = (50 - 40) 
Moderate: 30 = (70 - 40) 
Emergency: 110 = (150 - 40) 


RS-2 


70-150 

Avg . 110 rad 


Negligible: N/A (50 - 110 = -60) 
Moderate: N/A (70 - 110 = -40) 
Emergency: 40 (150 - 110 = 40) 


RS-3 

* ■ -■■-., 


> 150 


Negligible: N/A (50 - 150 = -100) 
Moderate: N/A (70 - 150 = -80) 
Emergency: N/A (150 - 150 = 0) 



4-6. 



Table 4—3. Operations exposure guide. 
THE USE OF NUMBERS IN RADIATION GUIDANCE 



a. The Official System. There is an official system for recording the 
radiological exposure status of military units. In brief, the system provides 
for three radiation status categories to describe the radiation exposure 
status of all military units up to battalion size. These categories are: 
Radiation Status RS— 1 for those units with militarily negligible doses. This 
negligible dose is defined as 70 rad. RS-2 units have a dose of 70—150 rad, a 
significant but not yet dangerous dose. RS— 3 units have exposures in excess 
of 150 rad. These units are shown in Table 4—3. Any further exposure would 
be considered dangerous for an RS— 3 unit. The system also assigns "degrees of 
risk" to be associated with any new radiation exposure for military units in 
the various RES categories. One weakness in the system is seen in the fact 
that it includes no reference to how the exposure was accumulated. For 
instance: two units might both be in an RS— 3 category with a 150— rad 
exposure, although one unit collected that dose over a period of three weeks, 
while another got all 150 rad in an acute dose yesterday. Obviously, the 
first unit is in pretty good shape, while the latter unit is in a precarious 



MED447 



4-1 1 



position so far as new radiation exposures are concerned. The system operates 
in this way: Platoons record radiation exposure in 10 rad increments and 
report daily to company. Company reports to battalion headquarters. 
Battalion keeps records by platoon and company and reports battalion status to 
division headquarters through brigade. There are at least two "safety 
factors" built into the system. The exposure categories are "saf e— s ided . " 
Incapacitation thresholds are probably considerably higher than the 
limitations used in the system, especially when prolonged exposures are 
considered. There is also no allowance for recovery from radiation injury. 
It is simply considered as a bonus, and there is no doubt that it is a rather 
large bonus when dealing with acute exposures several weeks old or prolonged 
exposures delivered over periods of several weeks. NOTE: RS and RES can be 
used interchangeabi I i ty through out the subcourse. 

b. The Surgeon's Role. Once a unit has been assigned an RES category 
of 2 or 3 can it ever be returned to a lesser radiation exposure status? Yes, 
it can. This is a decision for the commander to make, although he must lean 
heavily upon advice from his surgeon in making the decision. The surgeon will 
offer suggestions for lowering RES categories based upon his knowledge of 
radiation effects, his evaluation of the overall state of health of the unit, 
and his experience, when and if he gets it. 

c. Operation Exposure Guides (OEG'S) . 

(1) This radiation exposure status recording system is intended to 
assist the commander and surgeon in the development of operation exposure 
guides. If you recall the definition of an operation exposure guide (OEG) , 
this is the maximum amount of radiation which a commander will permit his 
units to receive during a certain period of time or in accomplishing a 
particular mission. OEG's have their place in conveying radiation exposure 
guidance from the commander to subordinate units, but they never relieve the 
commander or his surgeon from the necessity of making decisions concerning 
radiation exposure. OEG's are more meaningful when applied to small units 
than to large ones, and more meaningful when dealing with completed fallout 
fields than when either fallout in progress or initial radiation is 
encountered . 

(2) OEG's are also more practical when applied to units such as 
combat units, which normally move about in the accomplishment of their 
missions. They are less practical when applied to those units which must 
establish a fixed, relatively immobile installation to accomplish a mission. 
For example, a surgical hospital full of patients is not mobile. It would be 
an exceedingly rare fallout situation which would allow the commander of such 
a hospital to evacuate staff and patients to a clear location without serious 
radiation exposure to both groups in the process. This leaves the hospital 
commander with only passive defense measures and judicious utilization of 
radiation shelter to influence the dose to his staff and patients. He can 
only minimize exposure with or without reference to any established OEG. If 
an OEG were established at 25 rad and the hospital commander found that, 
after shelter was achieved, the average dose to the unit rose to 30, 35, or 
5—0 rad, he still would have no choice but to continue as he is until some 
future time. In such a case, the establishment of an OEG has had absolutely 

MED447 4-12 



no effect upon the decisions of the commander and might as well not exist so 
far as that particular commander is concerned. 



4-7. COMMAND GUIDANCE RADIATION 

In developing radiation exposure guidance for the commander, the 
surgeon is severely handicapped in some respects, yet the provision of such 
guidance is essential. In many situations, the guidance cannot be specific, 
but must be given in general terms unless the commander is willing to make 
some rather arbitrary assumptions in order to provide the surgeon with a 
specific situation. It is certain, however, that radiation guidance cannot be 
given in the form of a few universally applicable numbers, as some surgeons 
and commanders would hope. Instead, radiation guidance must be custom- 
tailored to the situation at hand. The surgeon must remember also, as the 
commander does, that the radiological situation is not itself a determining 
factor, but must be considered together with all the other factors which the 
commander must evaluate in making his decision. It is incumbent upon a 
military commander in nuclear warfare to keep radiation exposure to a minimum 
commensurate with the accomplishment of his mission. He must depend upon his 
surgeon for advice and assistance in order to do this. Although at this point 
in time there are many factors tending to limit the surgeon's ability to give 
such guidance, with an appreciation for what is known and for what can be 
foretold, the guidance can be given and this important element of our 
obligation to the combat arms fulfilled. 



Section II. NUCLEAR ACCIDENTS AND INCIDENTS 



4-6 . GENERAL 

We have had nuclear weapons in our inventory since shortly after World 
War II. Continuous handling, storing, and transporting these devices have 
resulted in a few nuclear accidents. However, safety devices and procedures 
are such that we have never had an unplanned nuclear yield result from an 
accident. We should define just what is a nuclear accident — anything that 
causes serious damage to a weapon or to a weapons system. A weapon involved 
in an explosion, conventional or nuclear, an accident resulting in radiologi- 
cal contamination or an accident resulting in potential or actual public 
hazard must be considered as an accident and handled as such. 

4-9. SAFETY ASPECTS 

a. Personnel. The initial process in attempting to preclude an 
accident or incident is to screen all personnel prior to schooling or 
assignment in the field of nuclear weaponry or reactors. This screening is 
performed under the provisions of AR 50—5. It includes a screening of medical 
records and evaluation of any conditions which could affect the performance of 
individuals in these obviously sensitive positions and would preclude 
selection for these assignments. 



MED447 4-13 



b. Active Materials. Active materials were discussed in lesson 1, but 
are repeated here for emphasis. In order to get the tremendous energy release 
which we know is available from nuclear weapons, certain active materials must 
be present. These are mainly uranium or plutonium and tritium. These 
materials are used both in our fission weapons and in our fusion or 
thermonuclear devices. In the fission process we bombard these heavy elements 
with neutrons in order to get a fission reaction with consequent release of 
neutrons, and fission fragments in a large amount of energy. In this process 
the large nuclei are broken into smaller fragments. On the other hand, in the 
fusion process, we are using light elements and with the proper application of 
tremendous pressure and temperature, bring them together or fuse them to 
produce slightly heavier elements, neutrons, and again, a tremendous release 
of energy. 

c. Critical Masses. The basis of designing nuclear weapons safety is 
to prevent the formation of critical masses of fissionable material unless it 
is the intent to detonate the weapon. Let us now take a look at two possible 

weapon designs and see the real means by which safety is achieved. In other 
words, how do we prevent the formation of a critical mass at a time when it is 
not desirable? Keep in mind that from the time a weapon system is developed, 
safety is designed into it. Logical safety and specific methods of providing 
safety, then, are an integral part of weapons design. 

(1) The gun— assembly type weapon is made so that its active 
material is separated into two subcritical masses at opposite ends of a "gun 
tube." Without a critical mass it is impossible to achieve a nuclear 
detonation. Various c i rcu i t— breakers are incorporated into the activating 
mechanism that detonates the propelling charge. This provides positive safety 
from the standpoint of pushing the two subcritical masses together in order to 
make a supercritical mass. Various natural safety devices, such as a physical 
block in the gun tube, could also be incorporated. A block of this type would 
have to be physical ly removed before the propel I i ng charge could force the two 
subcritical masses together. 

(2) In an impl os i on— type nuclear device, the active material is 
essentially all in one piece but it is still subcritical because the density 
of the active material is not high enough to achieve super— cr i t ica I i ty . In 
this type of weapon the active material is surrounded by shaped high explosive 
charges. Each of these charges is designed to implode rather than explode 
upon detonation. Each of the high explosive shaped wedges has its own 
detonator and they must all be exploded or detonated s imu I taneous I y in 

order to compress the active material into a super critical mass to sustain a 
multiplying chain reaction and a subsequent explosion. The safety design 
here, of course, is the safety design of the electronic mechanisms used to 
detonate the high explosive detonators. The detonation of only part of the 
detonators will not result in the formation of a critical mass and, thus, will 
not result in a nuclear explosion. A partial high explosive detonation will 
probably blow the weapon apart and result in spread of the fissionable 
material in the immediate vicinity of the accident. 



MED447 4-14 



4-10. HAZARDS 

a. Unexploded high explosives present the greatest initial nazaro. 
This is because they may explode or at least become very sensit ve so that any 
handling whatsoever may cause them to explode resulting in casualties of 
personnel in the vicinity. All of our weapons use h;gh exo : osives to some 
degree. This material becomes extremely oangerous wnen suo ; ectea to fire or 
rough handling which may result from an accident. The h,gh expiosive may tren 
burn or explode. If it does not burn or explode there may be me-i t i ng of the 
high explosive and this melted product is much more sensitive and touchy than 
the original configuration. The presence of unexploded high explosives in a 
burning environment can generally be verified by noting torching white flames 
in and among the normal flames from a gasoline fuel fire. Chunks of 
unexploded high explosives gathered in the vicinity of an acciaent will 
generally be recognized by their yeilcwish color. Until emergency ordnance 
disposal personnel arrive and po I ice up these chunks and pieces of uneApiodea 
high explosives, medical personnel must be extremely careful and cautious in 
retrieval of casualties from this area. Only personnel such as explosive 
ordnance disposal (EOD), specifically trained in the handling of this 
material, must be allowed to handle it at the accident site. 

b. The second I isted hazards at the nuclear weapon accident site are 
Plutonium and uranium. These hazards are listed together because they are 
both heavy metals, both are radioactive, and both emit alpha particles. Of 
the two, plutonium is by far the greater biological problem and we will 
consider the hazard from plutonium knowing full well that uranium hazard will 
be taken care of in the consideration. These metals are not particularly 
hazardous within the configuration of an intact weapon; however, if a weapon 
has been in an accident and ruptured, plutonium contamination may be scattered 
on a relatively large area of ground. Under these circumstances there is 
always a possibility of contamination of anything in the area and the 
subseouent carrying of this contamination to other areas by the winds. The 
other primary source of plutonium or uranium hazard is a fire engulfing the 
weapon. Under these circumstances this material may Decome a fume and be 
carried away with the smoke from the fire constituting a large area problem 
deoending on wind conditions. It is under these conditions that there is a 
great possibility of this mater ial being inhaled by persons and animals who 

i nadver tent ' y get into the smoke cloud. Since ooth of these metais have an 
extreme'y long naif— life the decontamination problem resulting from an 
accident oeccmes extremely difficult. n some instances very large areas of 
ground may have to be scraped, collected, and bur i ed in a control led area. 
The inhalation hazard may oe minim>zeo by using some sort of respiratory 
orotection. The standard protective nssk w< I ' serve the purpose. 

c. A third ootential hazaro w; , i oe tritium, a radioactive isotope of 
hydrogen wh>ch emits a weak beta pa^t'c'e. As tritium is a light gas it 

d. Muses -acidly in : u e a r, and readily oxidizes to x orm tritiated water 
vaoor. it does have some prooert ies which make it an important hazard 
potentiat'y assoc.ated with nuclear weapons accidents. in an open environment 
tr i t i um will be rapidly dispersed in the atmosphere and present a problem only 
for a short period of time in the immediate vicinity of the accident. In an 
enclosed environment, however, tritium may be present in considerable 

MED447 4-15 



concentrations for relatively long periods of time and certainly must be 
considered as a serious hazard. Keep in mind that tritium, as tritiated 
water, may be readily incorporated into the body through the skin so that 
personnel working in this area must be required to wear full protective 
clothing impervious to water. 

d. Lead and other metals such as beryl Mum may be present in small 
quantities as a result of a nuclear accident. These nonradioactive materials 
are certainly minor hazards compared to the potential from the previously 
discussed items. Public Health Service personnel, however, should be aware 
that they exist, particularly if the accident took place in the vicinity of a 
water supply. Since the possibility of a fission reaction taking place 
accidentally is remote, the possibility that fission fragments will exist is 
equally remote. Obviously, if fission reaction did take place, we have a 
fallout problem. However, since the possibility of an unwanted fission 
reaction is essentially zero we will not particularly consider that 
possibility in peacetime nuclear accident planning. 

e. There are many factors that affect the relative hazard of 
radioisotopes taken internally into the body. Obviously, the quantity of the 
material entering the body is important. Equally important, probably, is the 
route of entry. Inhalation becomes a very serious problem with the subsequent 
deposition of this radioactive material in the lungs and possible absorption 
into the bloodstream. Many of the heavy radioisotopes commonly encountered 
are poorly absorbed from the gut and this becomes definitely a secondary route 
of entry. Other things such as the physical and chemical properties of the 
radionuclide, the metabolic pathway in the body, elimination, and biological 
half— life are important in assessing the relative toxicity or hazard from 
internally deposited radionuclides. 

4-11. A NUCLEAR ACCIDENT 

a. Since the likelihood of a nuclear accident is probably greatest 
while a weapon is being transported, let us now consider a nuclear accident 
resulting from a vehicle accident on a highway north of San Antonio. 
Accompanying the particular device will be a Courier Officer, an individual 
who has primary responsibility for that particular warhead in transit. He 
will have communications facilities available to him in his convoy as well as 
security personnel. After the accident has occurred, the courier or the 
senior surviving individual is responsible for contacting the commanding 
officer of the nearest military or government installation. That installation 
commander is responsible for furnishing all possible immediate support, such 
as additional security personnel or medical support to take care of 
casualties. The installation commander is also responsible for immediate 
notification of the Army Area Commander. In our example, the Fifth Army 
Commander would then assume responsibility for this accident through a nuclear 
accident and incident control officer or NAICO. The NAICO would be dispatched 
from the nearest Fifth Army installation and assume command at the accident 
site upon his arrival. To assist him in performance of his functions are 
several specialty teams as well as personnel to assist in specific areas. 



MED447 4-16 



b. There are teams which are furnished by the Department of Army upon 
request of the Army Area Commander through his NAICO. The first of these is a 
Radiological Advisory Medical Team or RAMT team. The RAMT team is a special 
team under the control of Health Services Command for the purpose of advising 
on radiological health criteria. The RAMT team is composed of one nuclear 
medical science officer (68B) , RAMT Leader; one Nuclear medicine officer (60B, 
61Q, 61R, or 61S), at least two specialists, MOS 91X20 or equivalent (91W20 or 
91S20 with additional training); and additional personnel as determined by the 
RAMT Leader. The RAMT teams are positioned at Walter Reed Army Medical Center 
and the 7th Medical Command. The RAMT team performs the following functions: 
They monitor casualties for radiological health hazards and exposure level 
criteria, (personnel at local hospitals do not have the capability to conduct 
alpha monitoring); evaluate survey data in order to advise the NAICO on 
release of contaminated areas for general occupancy; monitor medical 
facilities and equipment where contaminated casualties have been evacuated, as 
requested by the medical facility commander, and advise on containment of 
radiological hazards and decontamination of exposed patients, medical 
personnel, and facilities. The RAMT team advises on pertinent, early and 
followup laboratory and clinical procedures and are prepared to assist with 
only absolutely essential emergency medical care should the need arise. 

c. In addition to these special teams, organized and equipped 
specifically to support Army Nuclear Accident Plans, other personnel and 
equipment requirements are obviously going to be needed by the NAICO. The 
local medical facility will be required to evacuate, treat, and care for 
casualties or injured individuals at the site. Legal advice will become 
extremely important to the NAICO and a member of the Army Commander's legal 
staff will be furnished to the NAICO. Public information aspects become 
extremely important and a PIO specifically trained to handle nuclear accident 
information dissemination will be provided by the Army Area Commander. 
Security forces will be required to safeguard classified equipment and 
material until they are evacuated and to prevent unauthorized entrance of 
personnel into what may be rad io I og i ca I ! y contaminated areas. Obviously, 
emergency ordnance disposal will be required. Normally, an EOD individual 
specifically trained in the weapons system being transported accompanies the 
convoy. 

4-1 2 . SUMMARY 

In planning for medical support of nuclear weapons accidents we must 
plan from the standpoint of very rigid peacetime radiation protection 
standards, which rigidly control the exposure of individuals and personnel to 
sources of radiation. We should be convinced that safety design is inherent 
in design of any nuclear weapon system. Safety considerations are developed 
along with technology for design of the remainder of the weapons system. In 
nearly three decades of transporting nuclear weapons we have not had an 
accidental nuclear yield. Unexploded high explosives is the most important 
initial hazard at the scene of the nuclear accident. Once the unexploded high 
exp I os i ve is po I i ced by qua I i f i ed personne I , the major hazard will be 
Plutonium and uranium contamination, should it exist. The least likely of the 
hazards which will occur will be fission products because of the inherent 
safety design of nuclear weapons. Every local military and government 

MED447 4-17 



installation has the responsibility for providing what assistance they 
possibly can to a Courier Officer. This may be in the form of medical 
support, security forces, or communications. 8asically, the Army Area 
Commander is responsible for assuring that appropriate act<on 15 taken when an 
Army owned nuclear weapon is involved in an accident in his geograpnicai area. 
He exercises his responsibility through a nuclear accident and inc. cert 
control officer. The NAICO has at his disposal specialized teams, sucn as the 
Radiological Advisory Medical Team, to assist him in exercising his duties. 
Additionally, legal and public information, security, emergency ordnance 
disposal and other support is available from the Army Area commander. 



MED447 4-18 






EXERCISES, LESSON 4 

REQUIREMENT. Answer the following exercises by marking the lettered response 
that best answers the question; or by completing the incomplete statement; or 
by writing the answer in the space provided at the end of the question. 

After you have completed all the exercises, turn to "Solutions to 
Exercises" at the end of the lesson, and check your answers with the 
so I ut i ons. 

1. In any situation, but particularly in a mass casualty situation, what 
is an effective individual? An individual who is: 

a. Fear fu I . 

b. Caref u I . 

c . Fear I ess. 

d. Capable of performing an assigned task. 

e. Motivated to such a high degree that no task is impossible. 

2. From the operation exposure guide table, it can be seen that a 
radiation exposure status of RES— 2 places a unit in a single exposure criteria 
of for any further exposure. 

a. Neg I ig i bl e. 

b. Moderate. 

c. Emergency. 

3. An individual who is at 10 percent physical effectiveness would 
normally be considered capable of which of the following tasks? 

a. Firing a preplaced weapon. 

b. Dr i v i ng a veh i c I e . 

c. Aiming a weapon. 

d. Hand— to— hand combat. 



MED447 4-19 



4. Generally about what portion of a unit is incapacitated if it is 
considered ineffective? 

a. 1/2. 

b. 1/3. 

c. 1/4. 

d. 1/10. 

5. Which of the following const i tute (s) radiological rest for a combat 
un i t? 

a. All of the choices below. 

b. Removing the unit to a non— combat area in the theater of 
operat i ons . 

c. Suspending duty activities immediately after the unit is 
i rrad i ated . 

d. Sheltering the unit in radiation shelter. 

6. What constitutes the major initial hazard in dealing with nuclear 
ace idents? 

a . PI uton i urn. 

b. Unexploded high explosive. 

c. Uranium, 
d . Tr i t i urn. 

7. If the radiation exposure status of a unit is RES-2, the total past 
cumulative dose is about rad. 

a. 25. 

b. 100. 

c. 200. 

d. 250. 



MED447 4-20 



8. By an acute dose , we mean the total radiation dose accumulated: 

a. During the first 5 minutes after a nuclear detonation. 

b. During the first hour after a nuclear detonation. 

c. During a 24— hour period. 

d. Over a period of three weeks. 

9. Which of the following is the appropriate action to be taken by a 
commander who knows that his troops have received a radiation dose which will 
probab I y be I etha I ? 

a. Get as much out of them as possible as long as they are at least 
somewhat effective. 

b. Evacuate all of them immediately regardless of the mission. 

c. Evaluate the urgency of the mission against possible chances of 
recovery and make his decision based on his best judgement. 

10. Who should assume command ano control Bt the immediate site of a 
nuclear accident? 

a. The Courier Officer. 

b. The Army Commander. 

c. The Radiological Advisory Medical Team leader. 

d. The Nuclear Accident and Incident Control Officer. 



MED447 4-21 



SOLUTIONS TO EXERCISES, LESSON 4 

1 . d (para 4-3a) 

2. c (Table 4-3) 

3. a (Table 4-1) 

4. b (para 4-3b) 

5. d (para 4-4e(4) ) 

6. b (para 4-10a) 

7. b (Table 4-3) 

8. c (para 4-2 c) 

9. c (para 4-4b(4) ) 
10. d (para 4-1 1) 



MED447 4- 2 ; 



LESSON ASSIGNMENT SHEET 



LESSON 5 

LESSON ASSIGNMENT 

MATERIALS REQUIRED 



LESSON OBJECTIVES 



SUGGESTION 



— Medical Operations in Fallout. 

— Paragraphs 5-1 — 5—24. 

--Map, Helotes, 1:50,000; overlay, simplified fallout 
predictor attached in rear of subcourse booklet). 

--Before you study the Problem Situation in Section II 
of the text assignment, "set up" the map and overlay 
for easy quick referral. Become familiar with the 
locations of units before you begin the step— by— step 
instruction for this specific situation. 

--After completing this lesson, you should be able to: 

5—1. Construct a simplified fallout predictor. 

5—2. Describe current concepts of medical operations 
in fallout to specific situations. 

--After completing the lesson assignment, complete 
the exercises of this lesson. These exercises will 
help you achieve the lesson objectives. 



MED447 



5-1 



LESSON 5 
MEDICAL OPERATIONS IN FALLOUT 

Section I. BACKGROUND 
5-1. INTRODUCTION 

a. Successful medical operations on trie nuc ear oatt;e f ie a require 
timely and knowledgeable decis ; ons. Surgeons, unit commanders, ana staff 
officers must understand the problems . mposed by a nuciear environment. 
Decisions concerning how to minimize the ef f ect pf blast, thermal radiation, 
and initial nuclear rac at:On must oe maae in advance of me event. "nose 
things which must be accomo 1 : s K ed to minimize the prompt effects are simp.e 
and stra ■ gnt f orwara : dispersion, aneiter, ana avoiaance of i i ke i y nuclear 
targets. Once a bomb has exploaed, there is I ittle one can do to alter the 
number of casualties which may be proaucea. 

b. 'n the case o* fallout, things are quite different. The fallout 
r adiat ; on nazard may cover thousanas of square kilometers ana persist for many 
hours or even days. The r e is not only time to make dec.sions but a vita, 
necessity that they be maae. These decis.ons will not merely affect tne 
outcome, they will determine it. 

5-2. PRIMARY PROBLEMS IN FALLOUT 

Vedical personnel and medical units generally will be faced with two 
or imary problems when operating in a significant local fallout situation. The 
first of these is unit survival and tne second is the performance of the 
mi ss i on . 

a. Unit Survival. To survive in a fallout situation the existence of 
the hazard must first be recognized. Information pertaining to the locaticn 
snd intensity o* r ad i o ! og i ca I I y contaminated areas may be provided the medical 
-nits by higher headquarters. In all probabi ity, however, medical units will 
'■■=:= ve tt'e warning of impending faliout. Even if this information were 
available in sufficient t'me to the medical ur t, it would not necessarily 
'eoresent tne key to action. It wi!i oe tne unit NBC Defense team wnich will 
retermire t u e presence or absence o* fa I 'cut, :: : ect and analyze the rad>ac 
jata, and ass.st tne medical ccmmanaer .n formulating decisions as to tne 

a:t org "ecessary *or un t su r v va I . T he unit team will make use of radiac 
^st-uments i ■"' deal ng w'tn *a!!out -3d'3t:on -azaras. Some of the radiac 
^st^jrents available to a combat support hospital are t h e Radiac set 

-': °DR-2 7 , Dosimeter Charger PP-157SA/PD, T acticai Dosimeter .M-93/UD and 

D a: acmete- IM-174A/ D D. 

b. Performance of Mission. 

(1, Should evacuation of patients to a shelter area become 
necessary, professional care has to revert to s : mple supportive measures and 
surgical crocedures I imited to those urgently required to save I i f e and I imb. 

MED447 5-2 



(2) Personnel should remain in sneiter during fallout unless 
specifically authorized to leave shelter sooner to perform a specif.c task. 
Prior to authorized departure from shelter during fa. .out, the departing 
individual should be briefed by monitoring oerscnne' jn precautions to oe 
observed and he should have a radiac dosimeter actacnad to his cio"ing. 
Rotation of personnel who leave the shelter should be practiced. 

(3) Unit NBC Defense personnel snouid ma<e radiation oac<grouna 
readings in the open. The radiological situation ns:de the shelter shoulc Pe 
determined early. While transmission factors of typical shelters have been 
computed and are shown in Appendix A, GR 76-332-100, page A-8 , the actual 
protection should be determined with the proper instruments. 

5-3. CONTAMINATION OF FOOD, WATER, PERSONNEL, AND MATERIAL 

a. Food and Water. After a nuc.ear attac<, in addition to protection 
from external radiation exposure, it is important that personnel in the 
fallout area be protected from internal radiation exposure due to the 
ingestion of rad i oact i ve I y contaminated food and water. Although tne 
ingestion of contaminated food and water is not an immediate threat to 
survival, there is the possibility of 'ate somatic and genetic effects. It is 
essential, therefore, that every effort oe made to remove the radioactive 
material from food and water prior to consumption to prevent this material 
from getting into the body. Such procedures, however, should not interfere 
with tactical operations. All unpackaged and uncovered foods, such as 
vegetables, fruits, and carcass meats, should oe considered contaminated if 
obtained from a known fa I lout field. These things can be decontaminated by 
washing, trimming, or peeling the outer skin or leaves. Nonper i shab I e items 
that cannot be readily decontaminated, such as flour, sugar or salt, can be 
set as'de al'ow.ng i~atu^a ; radioact.ve decay to reduce the rad i oact i v i ty to 
acceDtable I eve '■ s. ' f x cod supplies are c tcally low, contaminated food may 
have to be consumed. n this event, it may ce advisable to dilute the 
contamination by mixing wth uncontam i na ted £ cod. This will reduce the total 
amount o* radioactivity to a level where exposure will be mini ma I. Boiling or 
cooking contaminated food has no effect in r emoving that fallout material. In 
oackaged containers, such as cans, fibarbcard, and cellophane, most of the 
contamination ,3 not in the food but on the ca:<age. This simple expedient of 
brush i Pg or washng the dust f ron the container w.;l remove most of tne 
r adioactive material. The ingestion of contaminated water can be avoided if 
certain precautions are taken. Wate r ■,-. canteens, tan<s, cans, or other 
sealed sources wi ! I r ot oe contaminated bv '3 :-t and will be safe for 
drinking. 'he same s jSuai.y true for .vater '"om ground sources, such as 
.veils, anj spring wate r Wate r in d ce ' nes, covered r eservcirs, and other 
containe r s will be free from radioact.ve contamination. Water in streams is 
more likely to cont3'-> ess r aaioactv tv than that from lakes and ponds due 
to dilution. Water o^awn from oe I ow tne surface will contain relatively low 
concentrations of radioactivity. 

b. Personnel. T ne radiological decontamination of personnel should be 
accomplished as soon as the situation permits. If there is time and the 
tactical situation permits, personnel should bathe, using plenty of soap and 
water, preferably warm. Particular attention should be given to skin creases, 

MED447 5-3 



hairy parts of the body, and the fingernails. After decontamination is 
adequate, as determined by monitoring, personnel should be issued clean 
clothing. Personnel decontamination stations or quartermaster shower 
facilities should be used whenever possible. When personnel are prohibited by 
the tactical situation from using the normal decontamination procedures, they 
may use field expedient procedures to include shaking and brushing of 
clothing. Personnel should wipe all exposed skin with a damp cloth and remove 
as much radioactive dust as possible from the nair and from under the 
f i ngerna i I s . 

c. Material. Medical equipment and facilities are also subjected to 
contam i nat i on . 

(1) C I oth i nq . Decontamination of clothing is a primary mission of 
supply and service units and chemical processing units. In emergencies, 
personnel or units may be required to decontaminate their own clothing. This 

is accomplished during personnel decontamination or whenever possible, 
following as nearly as possible general laundering procedures. Rubber and 

leather items are decontaminated by washing with detergent and water. 

(2) Vehicles and equipment . The method most desirable for the 
decontamination of vehicles and equipment is aging. This method can be used 
only when there is not an immediate need for the vehicle and the contaminant 
is not too long I ived. Brush loose, dry contamination from the vehicle before 
starting the aging process to preclude adsorption of radioisotopes which 
become dissolved in rainwater or other moisture. In the event that the 
vehicle is required for early use, brush loose contamination from the surface 
and clean the vehicle by washing and scrubbing with steam or water and 
detergents . 

(3) Roof and wails of buildings . Buildings should be 
decontaminated by aging unless required for operations. Contamination of 
buildings will generally be in dust form (fallout). It should be removed by 
hosing the building with water. This procedure is especially effective if the 
building has a smooth sloping roof and smooth— f i n i shed sides. The removal of 
lightly adsorbates contamination is aided by scrubbing with or without 
detergents. A flat— roofed building is decontaminated in the same manner but 
with some difficulty. Cinder and tar or aspha i t tile roofs will physically 
trap some of the contaminant. Although the wet procedure is the most 
practical method for buildings with brick or stone walls, water carries some 
of the contamination into the surface pores. 

5-4. EVALUATION OF RADIATION CONTAMINATION 

a. Under the threat of or actual conditions of nuclear warfare, units 
in the field must continuously evaluate the impact that enemy use of nuclear 
weapons has on the conduct of operations and be prepared for contingency 
action to reduce the disruption caused by a nuclear attack. Fallout may be 
employed to blanket areas of poorly defined targets, create obstacles, 
canalize movement, disrupt conduct of operations, and force relocation of 
support installations. Casua I ty— produc i ng levels of fallout can extend to 
greater distances and cover greater areas than most other nuclear weapon 

MED447 5-4 



effects and can, therefore, influence actions on the battlefield for a 
considerable period of time. Knowledge and understanding by commanders and 
individuals at all levels of the radiological contamination aspects will 
permit the commander to determine accurately the advantages and disadvantages 
of each course of action open to him in the execution of assigned missions. 

b. The dose rate at any location within a contaminated area does not 
remain constant but decreases with time. Thus, in time radiation hazard will 
be of no military significance. The rate at which this decay takes place also 
varies with time, generally becoming slower as time passes. The decay rate 
for contamination in an area depends upon many factors and generally cannot 
be accurately determined until several series of dose— rate readings are 
available for specific locations within the contaminated area. Standard decay 
conditions are therefore assumed by all units until actual conditions are 
determined or until higher headquarters directs otherwise. (A decay exponent 
of 1.2 has been established as standard and is used by all units unless they 
have been informed otherwise by higher headquarters.) 

5-5. THE FALLOUT AREA 

Fallout areas will be the largest of the contaminated areas produced on 
the battlefield. One particularly important aspect of fallout is that the 
direction of fallout from ground zero is based upon winds aloft as well as 
upon surface winds. Thus, the actual location of fallout can differ 
appreciably from that which might be expected from the direction of surface 
wi nds . 

a. Automatic Fallout Response. The rapid onset of fallout, especially 
from small yields, within a few kilometers of ground zero of a surface burst 
requires quick adoption of protective measures. The time after burst before 
onset of fallout near ground zero will vary, depending on the yield of the 
nuclear detonation, weather conditions, and type of terrain. Normally, use of 
shelter will be automatic whenever nuclear bursts are observed, since these 
bursts should be assumed to be fallout producing until monitoring and the 
passage of time prove otherwise. During the period of uncertainty, 
precautionary measures consistent with the mission are instituted. 

b. Physical Recognition of Fallout. Particles are often visible 
during hours of daylight. The arrival and settling of dustlike particles 
after a nuclear burst occurs should be assumed to indicate the onset of 
fallout unless monitoring shows no radiation in the area. 

5-6. DOSE RATES 

a. Ground Dose Rates. The ground (outside) dose rate is the 
unshielded dose rate measured 1 meter above ground level (about waist high). 
This dose rate approximates the average whole body dose rate a man would 
receive if he were standing in the open in the contaminated area at the 
location of the measurement. Ground dose rates are the basic reference used 
to determine the magnitude of a contamination hazard. All dose rates 
mentioned in radiological intelligence are ground dose rates unless otherwise 
specified. Thus, all dose— rate info r mation obtained under conditions that 

MED447 5-5 






would modify the ground dose rate wou ' d be converted to ground dose rates for 
radiological intelligence purposes. 

b. Factors Affecting Determinations of Ground Dose Rates. Because 
some radiation is shielded out, the dose rate inside a vehicle or shelter is 
lower than the ground dose rate at that location. The degree of shielding 
depends on the type of vehicle or the construction of the shelter. Dose rates 
measured in an aircraft flying over a contaminated area are lower than the 
corresponding ground dose rates because of the shielding effect of the air and 
the aircraft. 

c. Transmission Factors. A transmission factor (TF) is a measure of 
the degree of shielding afforded by a structure, vehicle, fortification, or a 
set of specified shielding conditions. The transmission factor is that 
fraction of the outside (ground) dose or dose rate which is received inside 
the enclosure which provides the shielding. Transmission factors of common 
types of vehicles, structures, or fortifications are contained in the Appendix 
A, GR 76—332—100, p. A-3 . These transmission factors were establ ished, in the 
case of a combat vehicle, by determining the shielded dose or dose rate for 
the most exposed occupant location and, in the case of a structure or 
fortification, by determining the shielded dose or dose rate at approximately 
the center of the shielded volume. Transmission factors determined in the 
field require two dose-rate readings taken about the same time within 3 
minutes; one will be an outside (ground) dose— rate (OD) reading and tne other 
an inside (shielded) dose— rate (ID) reading. The transmission factor can then 
be calculated using the formula below: 

Transmission factor = Inside dose or dose rate or 






Outside dose or dose rate 



- I D 



TF = _|_°_ and by mathematical rearrangement: ID = TF X OD and OD 

OD TP 



5-7. ILLUMINATION TIME 

As a field expedient, yield may be estimated from the measurement of 
the illumination time of a nuclear burst, especially during hours of darkness 
or Door visibility. However this method should be used on I y if it is 
impossible to obtain cloud parameters since this method only gives a yield 
estimate on the order of a factor— of— 1 . Techniques for measuring illumina- 
tion time will vary, depending on the situation, but under no c i rcumstances 
should the observer attempt to look directly at the fireball since this can 
result in permanent damage to the eyes. The illumination time may be 
estimated by the observer who has taken shelter in a foxhole by noting the 
light reflected into the foxhole. The observer can look at the floor of the 
foxhole and still sense the duration of the flash or reflected light. 
Counting in seconds will probably be the most effective way of determining the 
illumination time since the "dazzle" (flash blindness) effect will preclude 
the reading of watches. Page A-33 , Appendix A, GR 76-332-100, shows rough 
estimations of yield, using illumination time. 



WED447 5-6 



5-6. SIMPLIFIED FALLOUT PREDICTION 

a. General. To satisfy command requirements at all echelons, two 
procedures for predicting fallout from a single detonation are established as 
explained below. 

(1) The primary procedure consists of a deta i led method to be 
employed by the Nuclear, Biological, and Chemical Element, (NBCE) in preparing 
fallout predictions for use by major commands and subordinate units. 

(2) The supplemental procedure consists of a s imp I i f i ed 
method that can be used by any unit. The simplified method employs a 
simplified fallout predictor which may be either the standard Area Predictor, 
Radiological Fallout, M5, (see FM 3-22, para 31) or a field constructed 
simplified fallout predictor. In a nuclear war, it may be expected that 
small, mobile units will be operating in widely dispersed areas. In such 
situations, receipt of a detailed fallout prediction (NBC 3 (Nuclear) report) 
from major command headquarters may be delayed for significant periods of 
time. The supplemental procedure provides small units an immediate capability 
of estimating the location of a potential fallout hazard, thereby allowing 
greater unit sel f— suf f ic iency . The estimate made of the fallout hazard using 
the simplified method will be less accurate than that made using the detailed 
method. 

b. Significance of Predicted Fallout Zones. 

(1) Inside the predicted area . In both simplified prediction and 
detailed prediction, the predicted zones define those areas within which 
exposed, unprotected personnel may receive militarily significant total doses 
of nuclear radiation (that which may result in a reduction in their combat 
effectiveness) after actual arrival of fallout. A zone of primary hazard 
(Zone I) and one of secondary (Zone II) are predicted. 

(a) Zone I delineates the area of primary hazard and is 
called the Zone of Immediate Operational Concern . It is defined as a zone 
within which there will be areas where exposed, unprotected personnel may 
receive doses of 150 rad (the emergency risk dose), or greater, in relatively 
short periods of time (less than 4 hours after actual arrival of fallout). 
Major disruptions of unit operations and casualties among personnel may occur 
within portions of this zone. The actual areas of major disruption are 
expected to be smaller than the entire area of Zone I; however, the exact 
locations cannot be predicted. The exact dose which personnel will receive at 
any location inside Zone I is dependent upon the dose rate at their location, 
the time of exposure, and protection available. There is, however, a 
reasonably high assurance that personnel outside the boundary of Zone I wi I I 
not be exposed to an emergency risk dose in less than 4 hours. The radiation 
produced from neutron— i nduced activity will be closely confined to the area 
around ground zero, which will be well within the limits of Zone I. The 
induced radiation will therefore have no effect on the extent of Zone I but 
will cause higher dose rates in the area around ground zero. Thus, the dose 
from induced radiation was not considered in determining the extent of Zone I. 



MED447 5-7 






(b) Zone I I delineates the area of secondary hazard and is 
called the Zone of Secondary Hazard . It is defined as a zone within which the 
total dose received by exposed, unprotected personnel is not expected to reach 
150 rad within a period of 4 hours after the actual arrival of fallout, but 
within which personnel may receive a total dose of 50 rad (the negligible risk 
dose), or greater, within the first 24 hours after the arrival of fallout. 
However, only a small percentage of the personnel in the zone are expected to 
receive these doses. The exact dose personnel will receive at any location 
within Zone II is dependent upon the dose rate at their location, the time of 
exposure, and protection available. Personnel located close to the extent of 
Zone I wi I I normally receive higher doses than those located close to the 
extent of Zone II. Personnel with no previous radiation exposure may be 
permitted to continue critical missions for as long as 4 hours after the 
actual arrival of fallout without incurring the emergency risk dose. If 
personnel in this zone have previously received significant radiation doses (a 
cumulative dose of 150 rad or more), serious disruption of unit mission and 
casua I ty— produc ing doses may be expected. 

(2) Outside the predicted area . Outside the predicted area, 
exposed, unprotected personnel may receive a total dose that does not reach 50 
rad in the first day (24 hours) after actual arrival of fallout. The total 
dose for an infinite time of stay outside the predicted area should not reach 
150 rad. Therefore, outside the predicted area, no serious disruption of 
military operations is expected to occur if personnel have not previously been 
exposed to nuclear radiation. Appreciable previous exposure should be 
considered. In either case, periodic monitoring coupled with routine 
radiological defense measures will normally provide adequate protection. 

c. Description of Fallout Prediction Method. 

(1) The simplified fallout prediction method is provided to enable 
small unit commanders to make an immediate estimate of the location of the 
potential fallout hazard without waiting for a detailed fallout prediction 
message from the NBCE's of major commands. 

(2) The simplified prediction method requires nuclear burst 
information, a current effective wind message, and a simplified M5 Fallout 
Predictor (or the construction of a simplified predictor). 

(3) The lateral or angular limits of the simplified fallout 
predictor are fixed at 40 degrees; this is in contrast to the determination of 
lateral limits from current winds in the detailed method. These fixed angular 
limits are based upon c I imato I og ica I studies. Thus, the simplified method 
provides the small unit commander with an "order of magnitude" estimate of the 
lateral limits of the area of hazard. However, both the simplified prediction 
method and the detailed prediction method use the effective wind speed in the 
same manner. Therefore, both methods present the same degree of accuracy in 
downwind distance. 



MED447 5-8 



d. Effective Wind Message. 

(1) Use of the simplified fallout predictor (or construction of 
one) requires knowledge of the effective wind speed and drection. Tr.is 
information is prepared by the ,\I6CE as an effect, ve wind message and s 
transmitted down to company level each time new upper a; r wind data are 
received. Since the effective wind speeds ano d.rections vary with yield, i,x 
wind speeds and directions are transmitted, corresponding to the six 
preselected yield groups. Effective wind messages more than 12 nours oia 
should be used with caution for fallout prediction. 

(2) The format for the effective w,nd message will be a series of 
seven lines, preceded by the Dhrase "Effective Wind Message," as follows: 

Effective Wind Message 

ZULU -DDtttt (local or ZULU, state which) 

ALFA -dddsss 

BRAVO -dddsss 

CHARLIE -dddsss 

DELTA -dddsss 

ECHO -dddsss 

FOXTROT -dddsss 

(3) The significance of each line is as indicated below: 

(a) ZULU DDtttt — This line is the date and time at which the 
winds were measured, with DD the day and tttt the hour in local or ZULU time 
(GMT) . 

(b) T he remainder of the I ines provide data for the six 
Dreselected yield groups, where ddd Is the e f fect've downwind direction in 
degrees from grid north and sss is the effective wind speed to the nearest 
k i I ometer per hour . 

J_. ALFA dddsss is the data line for the 2-kiloton (KT) 
or less y^eld group. 

2. BRAVO dddsss s t~e data ; i ne for the more tnan 2-i^T 
through 5— KT yield group. 

3. CHARGE dddsss s tne oata for the more than 5-KT 
through 30— KT y;eid grojp. 

4. DELTA dddsss ,s tie data I me for the more than 30— KT 
through !00— KT yield group. 

5. ECHO dddsss is the data i me for the more than 100— KT 
through 300-KT yield group. 

6. FOXTROT dddsss is the data line for the more than 
300-KT through the 1 megaton (MT) yield group. 



MED4A7 5-9 



(c) For example, if the DELTA I i ne of an effective wind 
message read DELTA 090025, the person using this information would know that 
the DELTA I i ne is used when the yield of the weapon is in the range from 30 KT 
through 100 KT. The contents of this DELTA line would indicate that the 
fallout prediction would be determined from an effective wind speed of 25 
kilometers per hour and an effective downwind direction of 90 degrees. 

e. Field Construction of Simplified Fallout Predictor. 

(1) If the fallout predictor (M5A2 radiological fallout area 
predictor) is not available, a predictor can be constructed from any pliable, 
transparent material, and to any desired scale, by the following procedure: 

(a) Step 1 . On a piece of pliable, transparent material, 
draw a thin dotted line (reference line) to a scaled length of 50 kilometers 
from a point selected to represent ground zero. This would appear as below: 



GZ i 



Reference 
L i ne 



(b) Step 2 . Draw two radial lines from ground zero at angles 
of 20 degrees to the left and right of the dotted reference line, as below: 




(c) Step 3 . On the side of ground zero opposite the 
reference line, draw a series of concentric semicircles (using the selected 
map scale) having radii of 1.2 kilometers, 1.9 kilometers, 4.2 kilometers, 6.8 
kilometers, 11.2 kilometers and 18.0 kilometers, which correspond to 
stabilized cloud radii from nuclear bursts with yields of 2 KT, 5 KT, 30 KT, 
100 KT, 300 KT and 1000 KT (1 MT) , respectively (fig. 5-1). 

(d) Step 4 . Label the semicircles constructed in step 3. 
Starting with the I i ne closest to GZ and moving up from GZ , label the I i nes A, 
B, C, D, E, and F; moving down from GZ , label the semicircles 2 KT , 5 KT , 30 
KT, 100 KT, 300 KT, and 1000 KT (1 MT) , respectively (fig. 5-1). 



MED447 



5-10 




Figure 5—1. Simplified fallout predictor, field 
construction (not drawn to scale). 



MED447 



5-1 1 



(2) To use the f i e I d— constructed fallout predictor, determine the 
downwind distance of the Zone of Immediate Operational Concern from nomogram, 
Appendix A, GR 76-332-100, page A-36. This determination is made by 
connecting the value of the effective wind speed and the point on the 
yield/scale representing the yield with a straightedge. The value of the 
downwind distance of Zone I, in kilometers, is read at the point of inter- 
section of the straightedge and the Zone I downwind distance scale. The 
downwind distance of Zone II is twice that of Zone I. Arcs are then drawn 
between the two >-adial lines, using GZ as center, with radii equal to the two 
downwind distances determined. Tangents are now drawn from the ciouo radius 
I i ne for the yield group to the points of intersection of the radial I i nes of 
the predictor with the arc representing the downwind distance of Zone I. 
Zones I and I I are now labeled and the radial I i nes between the two downwind 
arcs and the cloud radius I i ne are drawn in. T i me— of— arr i va i arcs of interest 
are drawn in, using the effective wind speed. The scale of the fallout 
predictor and the map must be the same. The resulting prediction is then 
oriented by placing a protractor over an actual or assumed GZ on the map and 
drawing a line to represent the effective wind direction for the yield group 
of interest. Place ground zero of the predictor over ground zero on the map 
and rotate the predictor until its reference line coincides with the effective 
w i nd d i rect i on . 



Section II. PROBLEM SITUATION 



5-9. INTRODUCTION 

a. The problem situations and solutions which foilow represent an 
effort to "bring together" information which may have been learned over a 
period of time and which is considered to be a minimum background for a 
medical commander or staff officer in providing medical support and advice to 
an infantry division under nuclear warfare conditions. Medical service 
support in a nuclear environment is a highly complex operation and extremely 
vital to the commander's success in battle as well as to the morale of the 
soldier. In the event of tact'cal employment of nuclear weapons, the 
commanding officer or staff officer of a medical unit will need to know how to 
successfully evaluate the radiological hazards encountered in the combat zone 
from the employment of nuclear weapons and radiological failout so that the 
medical mission may be accomp! ished. 

b. Whi le we at the Academy reai ize that this method of talking 
through" situations and solutions is not ideal, it does present specific 
problems a commander may experience and gives the student a chance to think 
through the problems befo r e the solutions are presented. Perhaps in no other 
way could so much be brought to the attention of the stuaent in terms of 
specific problems and situations in such concise form. 

c. Under normal classroom procedures, the construction of tne 
simplified fa! 'out prediction would be accomplished on the overlay as 
described in the step-by-step directions in the Appendix A, GR 76-332-100, 
page A— 31 and paragraph 5-8 above. Due to some limitations of the 

MED447 5-12 



correspondence method of instruction, the map and completed overlay are 
•furnished in order that the student may have a true picture of tne ur. .ts arc 
their locations, in relation to ground zero. If vou trace the step— by— step 
directions as given, you will be aoie to ascertain new tne overlay was 
constructed . 

5-10. GENERAL SITUATION 

a. The Fifth (U.S.) Army has been required to defend its geographical 
area of command responsibility against Aggressor Forces advancing from the 
West. 

b. One month ago tnis date, a strong Aggressor Force witn the help of 
U.S. Sympathizers overran the southwestern border defenses in the area of 
Nogales and Douglas, Arizona, and have attac<ed .n two main axes witnin 
striking distance of Los Angeles f r om the East and San Antonio from the West. 
The apparent overall plan is to gain a sufficient footnoid within the 
southwestern part of the United States to include Gulf and West Coast ports by 
taking control of New Orleans and San Francisco, sue for a cessation of 
hostilities in the interest of "peace," and so influence the political picture 
of the U.S. Government that tnrough 'peaceful coexistence" eventual control of 
the Government can be obtained by covert means. Phoenix, Tucson, and El Paso 
have been occupied by the Aggressors. The Aggressor's western push has been 
unhampered by large military forces, but substantial resistance was 
encountered east of El Paso. National Guard and Reserve Forces have been 
called to active duty. 

c. Though Aggressor Forces do not nave air superiority over the combat 
zone, they have available sufficient numbers of aircraft to employ nuclear 
weaDons. These airc-aft were obtained througn Aggressor mutual assistance 
oacts or they are caotured U.S. aircraft obtained by Aggressor sympathizers 
which were employed on U.S. Air Force bases. Of particular note is the 
Aggressor Forces' fanaticism for their cause due to political indoctrination 
which has resulted in some suicide missions 0/ ooth their ground and air 
forces . 

d. Aggressor Forces have tactical ly usee nuclear weapons up to 50 KT 
v • e ' d by Such de 1 very means as 155 mm M ow:tzer, 203 mm gun Howitzer, 250 mm 
^o r tar, ^ockets, and aircraft. Also, arc"".,c oeroiition munitions (ADM) have 
been used bv infiltrators within some c t ■ es and m ! i tar y bases. However , on 
the wHo I e , destruction of c 1 ty complexes nas oeen neid to a minimum tnrougn 

t h e use of chemical acents n co n S'de r arcn of cost— hostility reconstruction. 

5-1 1 . SPECIAL SITUATION 

a. The 98th Co-oat Succor: Hospital (CS^J is in support of the 36th 
Infantry Division in c e f e r s e of San Antonio with its numerous military 
i nsta 1 I at 1 ons . Military intelligence evaluates tne Aggressor's strength m 
its Eastern force to be about three (3) D'V ; sions which maneuver their forces 
in battal'on size units. In spite of tne losses suffered by the Aggressor 
p orces, their strength has been increasing due to U.S. revolutionary 
volunteers encouraged by the prospects of sharing in the mass looting which 

VEDA47 5-13 



has occurred in overrun areas. Currently, the 1st and 2d Brigades (Bde), 36tn 
I n f D'v, are in defersive positions along the forward edge of the battle area 
(FEBA) which extends on a line north— soutn 22 Km west of Camp Bull is. The 3d 
Bde, 36 Inf Div with the 1st Bn, 504th Armor attached, is in reserve. 

b. Reference to IX Corps directives reveals a maximum acceptable 
normal operational level of exposure to residua! nuclear radiation of 4 rad/hr 
for subordinate units while in a defensive position. Ten (10) rad/hr maximum 
exposure when in attack or retrograde movement is authorized. 

c. Location of units at 0900 hrs, this date (Ref: Map, Heiotes, 
1 :50,000) : 

HQ, 3d Bde, 36th Inf Div — vie IMH 273861 — Assume dispersion of troops in 

each Bde within an area 3 km in radius from the C.P. 98th CSH — NH 
361758 
HQ, 36th Engr Bn — NH 313817 

d. Mission: 98th CSH provides effective resusc i tat i ve surgery and 
medical treatment necessary to prepare critically injured or ill patients 
received from division medical elements for further evacuation; and in the 
event of an enemy NBC attack resulting in large numbers of patients, to be 
utilized in a manner comparable to that of an evacuation hospital. 

e. The 98th CSH closed in position 0600 hrs and became operational at 
1000 hrs, th is date. 

f. CO, 98th CSH is in the process of ma< i ng a I laison visit to the CO, 
Engr Bn . You are the medical operations assistant of the 98th CSH. 

g. The patient census of the 98th CSH at 1500 hrs, this date, is ten 
(10) litter patients who are awaiting evacuation by air to Brooke Army Medical 
Center at 1600 hours this date. 

h. Preliminary reconnaissance of your area discloses an aOandoned, 
dilaDidated one— story frame farmhouse with a 7 x 13 meter wide cellar with a 
ce'ling 4 meters high at NH 357759 and an old root celler 4x5 meters wide 
and 2 meters high some 30 meters away from the house. 

i. It is now 1518 hrs, this date. Your CO is still located at the 
Engineer Bn Tactical Operations Center. Elements of tne Engineer Bn have just 
submitted some nuclear burst information and he has relayed the data to you 
for your information. 

"Nuclear detonation observed to N.W. at 1515 hours. 
Mushroom stem observed 312° Magnetic. 
F I ash-to— bang time about 18 seconds. 
Illumination time about 2 seconds." 



MED447 5-14 



5-12. FIRST REQUIREMENT 

a. What preparations should you have had the unit make considering the 
Aggressor's use of nuclear weapons 7 

(1) Determine possible shelter iocations. 

(2) Determine where, how, and when hospital personnel and patients 
wil' take she I ter . 

(3) Allocate supplies necessary for proposed shelter. 

(4) Check operational status of RAD ! AC instruments. 

(5) Review standing operating procedures (SOP) for radiological 
operat i ons . 

b. What was the yield of the nuclear weapon? 

10 KT, as determined by an illumination time of 2 seconds. Ref: 
Appendix A, GR 76-332-100, p. A-33 . 

c. How far was the detonation from the engineer battalion? 

Approximately 6 km (the speed of sound travels at approximately 330 
meters per second or 1 km in 3 seconds). 

d. What initial effects from the nuclear detonation wouid be 
experienced by the 3d Bde and its attached Armor Bn ? Consider the troops 
located at 1,000; 2,000; and 3,000 meters from Ground Zero. 

Since a low airburst detonation maximizes the three initial effects 
of the weapon it wou^d be best, at this point, to assume a i ow airburst. 

Radius (meters) Ps i Cal/Sq/cm RAD 

1,000 6.1 (95 MPH Wind) 26 (3° Burns) 1600 

2,000 2.1 (30 MPH Winds) 5 (2° Burns) 14 

3,000 1.1 (18 MPH Winds) 2.1 (no Burns) Neg I 



From this data it is readily apparent that troops in the open at 
1 , 000 meters wil I have secondary mi ssile injuries, severe burns, and lethal 
radiation exposure. Even troops protected in foxholes will receive an LD 
50/30 of approximately 400 rad (1600 rad x 0.25). The TF of 0.25 is the 
approximate transmission factor for initial nuclear radiation in earth. At 
2000 meters only exposed personnel will be casualties (2° burns). At 3 , 000 
meters no casualties would be expected. Members of the Armor Bn who were in 
their tanks at the moment of the detonation would not have been injured by 
blast or thermal effects at any of the three distances. At 1 , 000 meters 
Dersonnel protected in tanks would receive some radiation dose; however, this 
dose cannot be quantified unless the tank transmission factor for initial 

MED447 5-15 



nuclear radiation is determined. The charts and graphs in Appendix A, 6R 
76-332-100, page 3, give TF values for residual radiation only. 

e. What initial effects (blast, thermal, and combined nuclear 
radiation) from the nuclear detonation would be experienced at the CSH? 

None. Ref: Appendix A, GR 76-332-100, pages A-40,41,42. 

f. Do you have sufficient information to make a fallout prediction 
plot if it is a surface burst? If not, what other information would you need? 

No, you cannot make a fallout prediction yet because you do not 
have any wind direction or speed information. You do have an est imated ground 
zero and yield estimation. A current "Effective Downwind Message" would give 
the wind information that is needed to make a prediction. Furthermore, the 
type of burst is still uncertain. 

g. Would you begin monitoring? Why? 

Yes, continuous rather than periodic monitoring with the I M — 1 74A/PD 
should be done. This means turning the instrument on and operating it 
continuously and frequently, perhaps every 5 or 10 minutes as determined by 
the CO, reporting a dose rate reading. Such cont i nuous monitoring should be 
done when: 

(1) A fallout warning is received. 

(2) CO orders monitoring to begin. 

(3) Nuclear detonation is heard . 

(4) Unit is moving on a nuclear battlefield. 

(5) Nuclear detonation has been observed, or reported . 

(6) A reconnaissance or patrol is made on a nuclear battlefield . 

(7) Radioactivity is greater than 1 rad/hr as determined by 
periodic monitoring. 

h. What radiac instruments are available in the 98th CSH that you 
could use to monitor for fallout? 

Use the IM-174A/PD to monitor for fallout in an area. Ref: 
Appendix A, GR 76-332-100, page A-20. 

5-13. SPECIAL SITUATION CONTINUED 

a. At 1500 hours, this date, the following Effective Downwind Message 
was received via telephone from S3, Med Bn: 

MED447 5-16 



ZULU DD1900Z 
ALFA 120005 
BRAVO 121010 
CHARLIE 123020 
DELTA 133056 
ECHO 146025 
FOXTROT 190080 

NOTE: Six (6) hours is added to local San Antonio time (Sierra time) to get 
Greenwich Mean Time (Zulu time). 

b. At 1524 hours this date, another telephone message from the CO, 
98th CSH is received: 

"The detonation: Surface Burst . 

Am returning to unit immediately. Prepare recommendations as to 
the need for hospital personnel to prepare and/or take cover in 
fallout shelters at the 98th CSH." 

5-14. SECOND REQUIREMENT 

a. What is your recommendation to the CO? 

Before a recommendation to the CO, 98th CSH can be made, a 
determination must be made as to the possible radiological hazard which may 
result from this nuclear detonation. The two problems of concern are first, 
taking cover if radiological contamination from the fallout will probably 
occur and second, disruption of the medical mission should there, in fact, be 
no need to take shelter. These questions can be somewhat resolved by 
preparing a fallout prediction; therefore, a fallout prediction must be 
prepared to determine the need to take cover in the fallout shelters . I f a 
fallout prediction has not been made as yet, it needs to be prepared now. If 
a fallout prediction has been prepared, its validity is established by the 
information that the nuclear detonation was a surface burst. Evaluation of 
the prepared fallout prediction will establish the fact that the 98th CSH is 
i n Zone I ; as such, the recommendation should be to "Prepare to take cover" in 
the fallout shelters immediately. It is obvious that time would have been 
saved had a tentative fallout prediction been prepared prior to the actual 
knowledge that the detonation was a surface burst. 

b. Would you report this new radiological intelligence? Why? To 
which headquarters? 

No, because this information was not determined by you. Also of 
consideration at this time is a probable overloading of communications, and 
your information, which is hearsay, would add to this problem. However, if 
you did decide to report this information you would report it to the Med Bn 
and your parent Medical Gp. 

c. Prepare an NBC 3 (Nuclear) Report from the above information. 
(Ref: Appendix A, GR 76-332-100, pages A-6 thru 8, A-31,32 or FM 21-40, pages 
6-8 through 6-28) . 

MED447 5-17 



Precedence : 

Date/T ime : 

Security Classification: 

From: 

To: 

Type of Report: 

D. 

F. 

Y. 

Z. 



D. 
F. 
Y. 
Z. 



IMMEDIATE 

DO 21ttZ 

Unc I ass i f i ed 

98th CSH 

(NA) 

NBC 3 (Nuclear) 

DD 2115Z 

NH267856 estimated 

01030143 degrees 

02001403 



NOTE : An NBC 3 (Nuclear) report is in fact prepared at the NBCE of division 
or higher headquarters; you in reality would not be preparing such a 
report except to provide a quick means of giving information to your 
next higher headquarters. Your medical unit would receive an NBC 3 
(Nuclear) report from the NBCE, from which you would prepare a detailed 
fallout prediction (when constructed on your map, a simplified and 
detailed would look much the same). The purpose of the requirement of 
preparing an NBC 3 (Nuclear) report is to correlate the information 
contained in such a report with that which can be determined from an 
NBC 1 (Nuclear) report and an Effective Downwind Message. 

d. Prepare a simplified fallout prediction from the above information. 

The solution of this requirement can be seen when you trace the 
steps in the construction of the fallout prediction on the overlay, as 
described in Appendix A, GR 76 - 332—100. p. A— 31 . Ground zero can be estimated 
with the information furnished by the Commanding Officer of the 98th CSH who 
was located at the Division Engineer Battalion at the time of the nuclear 
detonation. From his position (313817), the observed mushroom stem was to the 
NW at 312° Mag. as determined by a compass reading, and a f I ash— to— bang time 
was about 18 seconds; with this information, draw a line from the CO's 
position at an angle of 320° grid (312° Mag. + 8° = 320° grid) and with a 
length of 6 km. The f I ash— to— bang time of 18 seconds gives a distance to the 
point of burst of approximately 6 km (from the speed of sound being 
approximately 330 meters per second). From this approximate position, we can 
see that it falls almost in the center of the 3d Bde, 36th Inf Div. 

With the arrival of information from the Commanding Officer, 98th CSH 
that the type detonation is, in fact, a surface burst, the necessity of a 
simplified fallout prediction is established. First, the approximate GZ 
(267856) is located on the map (6 km from 313817) at grid azimuth 320° with 
the location of GZ and an Effective Downwind Message, a simplified fallout 
prediction can be prepared. From the Charlie line (for a 10 KT weapon) of the 
Effective Downwind Message, the data given is 123020. From GZ draw a 
reference line at 123° ( 123 030) from GN; then, construct right and left radial 
lines at 20° from the reference line. From page A— 37 of Appendix A, GR 
76-332-100, a cloud radius of about 2.3 km is found for a 10 KT weapon. For 
immediate consideration increase 2.3 km to 3 km. Draw a circle of 3.0 km 
radius representing the cloud radius with GZ as its center. Then using GZ as 
center and a radius of 14 (from 020 014 03) an arc is drawn so that it 
intersects the left and right radial lines. Tangents to the circle of 3.0 km 



MED447 



5-18 



radius are drawn from the intersections of the radial lines and the 14 km arc. 
Zone I is the area formed by these tangents and the 14 km arc. Zone II is 
found by doubling the 14 km distance and describing a second arc of 28 km 
radius with center at GZ . Zone II is the area bounded by the first ana second 
arcs and the portions of the radial lines extending from the points of 
intersections of the tangents with the 14 km arc. 

5-15. SPECIAL SITUATION CONTINUED 

It is now 1530 hrs, this date. The following message from the S3 Med 
Bn is received by your unit over the field phone: 

Immed i ate 

DD 2125Z 

Unc I ass i f i ed 

Hq, 36th Inf Div 

All subordinate Hq , this Cmd 

NBC 3 (Nuclear) Report 

D. DD2115Z 

F. NH267856 actual 

Y. 01030143 degrees 

Z. 02001403 

5-16. THIRD REQUIREMENT 

a. Does the above NBC 3 (Nuclear) Report agree with your fallout 
prediction using the NBC 1 (Nuclear) report and the Effective Downwind 
Message? 

Yes. 
Ik Is your unit in the path of fallout? Which zone, if any? 

Yes . Zone I . 
c. What is the military significance of: 

Zone I? Zone II? Areas outside Zone I or II? 



(1) Zone I: Zone of Immediate Operational Concern — zone within 
which there will be areas where exposed, unprotected personnel may receive 
doses of 150 rad or greater, in relatively short periods of time (less than 
four hours after actual arrival of fallout). 

(2) Zone II: Zone of Secondary Hazard — zone within which total 
dose to exposed, unprotected personnel is not expected to reach 150 rad within 
a period of a 4 hours after arrival of fallout, but within which personnel may 
receive a total dose of 50 rad or greater within the first 24 hours after the 
arr i va I of fa I I out . 



MED447 5-19 



(3) Outside the Predicted Area — exposed , unprotected personnel may 
receive a total dose that does not exceed 50 rad in the first 24 hours after 
actual arrival of fallout. The total dose for an infinite stay should not be 
greater than 150 rad. 

d. Does the fal lout prediction mean that the 98th CSH def i n i tel y wi I I 
or will not receive radiological fallout in the amounts stated above for each 
zone? Why? 

No, it is a prediction which means that it may or may not occur. 
It does not state that it will abso I ute I y occur. 

e. What is the predicted arrival time of radiological fallout at the 
98th CSH? 

Forty-two (42) min after the nuclear detonation or about 1557 hrs, 
this date . The 98th CSH is approximately 14 km from GZ . From the Charlie 
line of the Effective Downwind Message the cloud speed is 20 km per hr (60 
min). 

20 km = 60 min 
1 4 km X m i n 

20x = 840 

x = 42 = Estimated time of arrival 

As the nuclear detonation occurred 1515 hrs, this date, this time plus the 42 
min arrival time means that the predicted arrival time of the radiological 
fallout would be approximately 1557 hrs, this date (CST) . 

f. In an evaluation of the situation, what considerations should be 
made as to your unit staying in or moving from its present location? 

(1) Mission of the 98th CSH. 

(2) Knowledge of where the radi logical fal lout def i n i te I y will not 
fall. This means that any reasonable area to which you could relocate the 
unit may be as bad or worse than your present position in regard to the 
hazards and/or dose rates of the fallout. 



(3) Required permission to relocate the 98th CSH as determined by 
the Med Group Commander . 

(4) T ime required by the 98th CSH to move to a new location. It 
will take time to prepare for a hospital to move to a new location. Naturally 
the farther away the new position would be, the longer the transit time. 



(5) Ava i labi I i tv of adequate shelters nearby. 



MED447 5-20 



g. Of the possibilities for action remaining after the considerations 
in f above, what course of action would you take? 

Of the possibilities for action, the logical course of action to 
follow, considering the time available, would be an attempt to take she I ter in 
your local area . Shelter facilities available in your area are (1) foxholes 
for perimeter guards and perhaps some additional personnel in the tent area of 
the 98th CSH and (2) the shelter provided by the farmhouse cellar and root 
cellar. The action required on your part would be to order "Prepare for 
fallout." As the time is now 1530 hrs, this date, and the expected arrival 
time of the radiological fallout is 1557 hrs, there remains only approximately 
27 min prior to arrival of fallout in order to close into the various shelter 
f ac i I i t ies. 



5-17. SPECIAL SITUATION CONTINUED 

The CO of the 98th CSH returned to the unit at 1534 hrs, this date. He 
has decided to follow your recommendation to make use of the cellar of the 
nearby old house as a fal I out shelter for unit personnel and patients. The 
root cellar is to be used for the headquarters section of the CSH. It is now 
1535 hrs, this date. 

5-18. FOURTH REQUIREMENT 

a. How wi I I the above actions affect the un i t 's miss ion? Why? 

Moving to shelters will reduce the abi I i ty of the 98th CSH to 
perform its mission by hampering mobility of personnel within the unit and by 
reducing facilities available to the unit. In addition, new urgent 
requ i rements will occur due to the certainly less than opt imum she I ter 
fac i I i t ies. 

b. What preparations should have been made for occupancy of the 
she I ters? 

Readily available food, water, and lighting . Continued communi— 
cat ion with the Med Bn switchboard. Any additional efforts to increase the 
protection factor of the shelters available; for example, digging deeper and 
providing top cover to foxholes and sandbagging the first floor above the 
farmhouse cellar. Also, considerations must be given for a continuation of 
the medical mission within the cellar shelter area. 

c. What time remains before the predicted onset of fallout? 

About 22 min . As the expected arrival time of the radiological 
fallout is 1557 hrs, this date and the present time is now 1535 hrs, 
approximately 22 min remain before the onset of radiological fallouts. 

d. Comment on the fact that sufficient time may not remain to have all 
unit personnel take to the shelters. 



MED447 5-21 



Do your best! It is quite imperative that all personnel take some 
type of protective action in the shelter facilities available. Space in the 
farmhouse or root cellar may not be available to all personnel. Some 
personnel in addition to the perimeter guards may have to take shelter in 
f oxho I es . 

e. Have a I I the unit personnel been ordered to the farmhouse shelters? 



Why? 



tent area 



No. Some personnel are required as perimeter guards around the 



f. Has coordination concerning the movement to shelters been made with 
other headquarters? Which ones? 

The following units should be informed of your relocation to the 
shelter area due to the radiological fallout: supported medical battalion, 
supporting evacuation hospital, and the parent medical group. 

g. What do you expect the TF for the eel lars to be? The PF? 

TF for this type of shelter is 0.1 ; the PF (being the reciprocal of 
the TF) is 10. This information is provided in Appendix A, GR 76-332—100, 
pages A— 2 and A-3 . 

h. How much would one layer of sandbags about 6.6 inches thick on the 
floor above the house eel lar reduce the radiation exposure from overhead ? 
Why? 

The two half— value layer thicknesses of earth in sandbags would 
reduce the overhead radiation to one— fourth (1/2 x 1/2 = 1/4) or 25'/. ; however, 
this reduction applies only to that radiation which comes into the shelter 
from overhead and cannot be appl ied to the estimated TF across the board. The 
best you can say is that it will help, but you cannot quantify your estimate. 
Ref: Appendix A, GR 76-332-100, page A-5 . 

5-19. SPECIAL SITUATION CONTINUED 

You are still the medical operations assistant. At 1600 hrs, this 
date, one of unit's monitors reports 1 rad/hr. At 1608 hrs, this date, the 
same monitor reports an outside dose rate of 5 rad/hr. During the stay ±n the 
farmhouse cellar shelter , the following readings on your radiac instrument are 
observed : 



Time after Inside Outside 

Time Detonation Dose rate (rad/hr) Dose rate (rad/hr' 

1600 H + 45 min - 1.0 

1605 - 5.0 

1610 - 15.0 

MED447 5-22 



1620 5.0 100. 

1640 7.5 

1650 8.7 

1700 10.5 

1715 H + 2 10.0 

1730 9.0 

1745 7.7 

1800 7.0 

1900 4.5 

2000 3.5 

2100 2.7 

2200 2.6 

2300 2.0 

2400 1.7 

Next Day 

0300 1.3 

0600 0.8 

0900 0.7 

1200 0.6 

At 1620 hrs, you order a monitor outside the house/cellar shelter 
to take an outside dose rate reading which he reports as 100 rad/hr. His stay 
t ime was 5 mi nutes . 

5-20. FIFTH REQUIREMENT 

a. What actions do you have the unit personnel take upon being 
informed that 1 rad/hr has occurred? Take such action! 

(1) Order a!! personnel into or see tnat all personnel have 
entered the she I ters . A "contact report" (NBC 4), using IMMEDIATE precedence 
is submitted whenever an initial ground dose rate of 1 rad/hr or more is 
detected in an area within the predicted fallout area. 

(2) IMMEDIATE 
DD 2208Z 

Unc I ass i f i ed 

98th CSH 

HQ, 36th Inf Div (NBCE) thru Med Bn 

NBC 4 (Nuclear) 

Q.NH 361758 

R. 1 (initial ) 

S.DD2200Z 

b. How was the monitor instructed to take his outside reading? What 
radiac instrument should he have used 7 

By holding the IM-174A/PD waist-high or 1 meter above the ground 
while 10 meters away from any structure and rotating in a 360 degree circle. 
The monitor reports the highest dose rate reading? 

c. What is the actual PF cf the shelter in the cellar of the house? 
MED447 5-23 



Twenty . This is determined by an outside dose rate reading by the 
monitor at 1620 hrs, this date of 100 rad/hr. At the same time, or shortly 
thereafter, an inside dose rate of 5 rad/hr was determined. As the PF equals 
the outside dose rate divided by the inside dose rate (100 rad/hr divided by 5 
rad/hr), the overall PF for the house celler shelter is 20. As would be 
expected, the calculated or actual PF is somewhat different than the stated PF 
in the reference material since the actual PF would be dependent upon 
composition of cellar wall, thickness of the cellar wall, composition of the 
surrounding soil, depth within the ground of the cellar and composition of 
overhead ceiling material. In this particular case, the overall protection 
factor within the cellar shelter is greater than 10. But because the overhead 
two HVL's of earth of the ce i I ing of the eel lar does not shield against al I 
radiation entering the shelter, the rated overall protection factor of the 
cellar is not increased by a factor of 4. This can be seen from the actual 
exposure rate determination of the shelter which is PF = 20 rather than PF = 
40 as might be expected from a shelter with an original PF = 10 and then 2 
HVL's of shielding added. 

d. Would you report the above experienced dose rates to any other 
units? Which? 

Yes , to the Div NBCE through the Med Bn and also to the Med Gp 
headquarters. 

e. What message form would you use? 

NBC 4 (Nuclear) Report . Ref: Appendix A, GR 76-332-100, page A-7 . 

f. How would you determine if the radiological fallout follows 
"standard decay ?" 

By the ABC-M1 Calculator . As the decay rate on the ABC-W1 
Calculator is based on the standard decay rate, if the decay rate is faster or 
slower than the decay rate given on the ABC-MI Calculator, it is non- 
standard. The radiological contamination in this situation is following a 
standard decay rate. 

g. Has the peak dose rate occurred? At what time? What is the 
s ign i f icance of th is? 

Yes, at 1700 hrs. this date . The significance of this is that 
decay calculations can now be made with the ABC-M1 Calculator or nomograms. 

h. How long would it be necessary to remain in the shelters for the 
occupants to obtain a dose of 25 rad? (Assume 7 rad dose up to H + 2 hours.) 

About 4 hrs . First subtract 7 rad, the quantity of radiation the 
occupants of the shelter have received up to H + 2 hrs, from the total overall 
dose of concern for the occupants which is 25 rad; thus 18 rad will remain for 
the shelterees to receive after H + 2 hrs. Then on the ABC-MI Calculator set 
the inside shelter dose rate of 10— rad/hr on the outer dial in line with the 
corresponding time of interest on the middle dial which is H + 2 hrs. Set the 

MED447 5-24 



inner dial to H + 2 hrs for the time of entry. Locate on the outer dial a 
total dose of 18 rad; following the guide line down to the inner dial which 
should read about H + 6 hrs and subtracting H + 2 from H + 6 hrs, this leaves 
4 hrs stay time in order to r eceive the 18 rad which with the 7 rad up to H + 
2 gives a total dose of 25 rad. (Ref: Subcourse, para 3-9). 

i. How long do you anticipate you must remain in the shelters from H + 
2 hrs until the outside dose rate decays to the command operational level? (4 
rad/hr.) What will be the total dose to the shelter occupants in that time? 

(1) The first consideration given to this question is what is a or 
the outside normal operational radiation dose rate level? This will not oe 
determined by an individual unit but a command SOP cased upon comparison of 
the risk due to a particular dose rate of radiation and the necessity to 
accomplish the tactical mission. Such a decision will be a command decision 
based upon willingness to receive resulting biological hazards of the selected 
dose rate as evaluated by the major command surgeon. The normal operational 
dose rate levels to nuclear radiation may very well vary within a major 
command dependent upon the various tactical requirements. It is naturally 
assumed that such operational levels have been established heretofore in SOP's 
and in contingency plans. 

(2) in this particular problem Hq, IX Corps has established as its 
acceptable normal operational dose rate level for units in a defensive 
position to be 4 rad/hr (Ref: Subcourse, para 5—11). By knowing that a H + 2 
hrs (1715 hrs, this date) the inside dose rate is 10 rad/hr and with a 
protection factor for the shelter of 20, the outside dose rate is calculated 
to be 200 rad/hr. Then by using the Rad i ac Calculator, ABC-MI, setting the 
middle dial at H + 2 with the 200 rad/hr located on the outer dial, the dose 
rate occurring due to standard decay can be determined for any period of time. 
By following the dose rate on the outer dial down to 4 rad/hr and reading the 
time at which this will occur on the middle dial, it is determined that an 
outside dose rate of 4 rad/hr will occur at approximately H + 2 days plus 4 
hrs or H + 52 hrs . (Ref: Subcourse, para 3-9). 

(3) To determine what the total dose is to the shelter occupants 
in that period of time, the inside dose rate must first be determined; the 
inside dose rate at H + 2 hrs is 10 rad/hr on the outer dial. By aligning the 

middle dial of the calculator at H + 2 hrs with 10 rad/hr on the outer dial, 
the inside dose rate based upon the standard decay of the outside radiological 
fallout can be determined. Next align the 2 hr mark of the inner dial with 
the time of entry mark on the middle dial. By observing the location of the 
2-day plus 4 hr mark on the inner dial (about the left third of the red band) 
and following this mark to the outer dial, a dose of approximately 46 rad is 
determined. Thus, approximately 46 rad will be the dose of the sheiterees 
during their stay for the period from H + 2 hrs to H + 52 hrs. To determine 
their dose for the total length of stay in the shelter, add the 7 rad received 
prior to H + 2 hrs to that 46 rad received after H + 2 nrs; thus, a tota l dose 



of 53 rad will be received by the sheiterees at H + 54 hrs . (Ref: para 3-9). 



MED447 5-25 



j. What is the dose rate to those personnel in house cellar shelter at 
1715 hrs? What is the dose rate in foxholes around the tent area at 1715 
hours, this date? How could the perimeter guards reduce this dose rate? 

(1) Ten (10) rad/hr as determined by inside monitoring. 

(2) As the outside dose rate at H + 2 hrs is 200 rad/hr anc the TF 
of a foxhole is 0.1, the dose rate to those personnel in foxholes at the tent 
area is 20 rad/hr . (200 X 0.1) Ref: Appendix A, GR 76-332-100, page A-3 . 

(3) The perimeter guards in foxholes could reduce this dose rate 
by digging deeper or providing some type of top cover. This could increase 
the protection factor to approximately 20 thereby reducing the dose rate at H 
+ 2 hr S to 10 rad/hr. (PF = 20; TF = 10/200 = .05; 200 x .-05 = 10 rad/hr). 

k. Five ambulatory casualties have been directed by a perimeter guard 
at the tent area to the house cellar shelter and arrive there at 0915 hrs, 
next day (H + 18 hrs). Do you admit them? As a result of your decision, what 
actions are taken concerning the casualties? Why? 

Yes , you wouid admit them to your shelter after they have Peen 
decontaminated. Of concern here is implementing all the precautionary 
measures possible to minimize exposure and contamination inside the shelter. 
At H + 18 hrs it will be noted that the dose rate inside the shelter is 
approximately 0.7 rad/hr, which is greater than the maximum range of the 
AN/PDR— 27, thereby nullifying its usefulness in these conditions. It would be 
logical to assume that these individuals traveling in the fallout field which 
is still emitting approximately 14 rad/hr would be contaminated from such 
radiological contaminants as acquired in the immediate area of this fallout 
field. Because of this and attempts to reduce contamination as much as 
possible, these persons now should remove, shake and/or brush outer garments 
to remove the gross contamination. Of course, this procedure would be 
performed outside the shelter area. Should assistance be needed by these 
individuals to accomplish this decontamination, selected shelterees would be 
sent outside the shelter to assist them. It is somewhat needless to say that 
any or all procedures needed to save any of the lives of the casualties would 
be performed pr i or to the precautionary decontamination procedures. In an 
attempt to determine total dose of radiation to these individuals, the IM-93 
should be checked, if available. 

5-21. SPECIAL SITUATION CONTINUED 

It is now 1515 hrs, next day (H + 24 hrs). As some shortage of food 
and water has occurred, you order two persons to obtain more C rations and 
water from the tent area. They return with ten 5— gallon water cans and three 
boxes of C rations. You assume all containers are rad i o I og i ca I i y 
contam i nated . 

5-22. SIXTH REQUIREMENT 

a. Do you recommend to CO that the food and water be used? Why? Of 
consideration here is the amount of contamination on the food and in the water 

MED447 5-26 



compared to the necessity of the shelterees to consume the food and water. It 
would be logical to assume that the C ration boxes would contain only outer 
contamination in which case the outer boxes should be cleaned or removed with 
caution to minimize contamination to the inner boxes. All of the radiological 
fallout at this time would be on the ground; therefore, such decontamination 
procedures to the C ration boxes should be performed outside the shelter with 
care being taken that after the inner boxes are removed they do not come in 
contact with the ground or surrounding surface radiological contaminants. In 
a similar fashion the 5— gallon water cans could be easily decontaminated 
assuming that these cans were filled in the old tent area prior to onset of 
fallout. Thus, the cans could be washed or dusted off before being taken into 
the shelter. Should such water cans be required to be filled from the water 
trailer still in the old tent area, such minuscule amounts of contaminants as 
may inadvertently gain entry into the water cans during their filling from the 
water trailer would be insignificant in relationship to the possible 
physiological hazards resulting to the shelterees from lack of water. In 
bringing anything into the shelter from the outside area, it would be logical 
to assume that it is rad io log ical I y contaminated and therefore should be 
decontaminated. 

b. Do you have the containers decontaminated before bringing them into 
the shelter area? Why? How? 

Yes , as stated in paragraph above. 

c. If they returned at 1545 hrs, what dose would you expect them to 
receive? Why? 

Approximately 5 rad. Practically, this dose determination would be 
made by the IM-93 carried by the personnel. Using the Rad i ac Calculator ABC- 
MI and aligning H + 2 hrs on the middle dial with 200 rad/hr, one can deter- 
mine that at H + 1 day the outside dose rate would be 10 rad/hr. As the 
personnel had an outside exposure for naif an hour their dose would be 5 rad. 
(30 x 10 = 5.) 
60 

d. Would you keep a record or log of the doses of personnel in the 
shelters? Why? 

Yes . Records as complete as practical should be maintained for all 
known exposure to the shelterees. Such records would then be of benefit in 
future evaluation of patients due to the possible complications in their 
recovery due to irradiation. Such records also provide information as to 
those individuals with minimum doses in case of the need of special tasks 
outside the shelter where they would receive additional outside exposure. The 
consideration here is to spread the radiation doses equally among selected 
shelter personnel so that the hazard of radiation to any one or few 
individuals is minimized. 

e. Would you report to any other units your dose rate levels during 
this time? Which units? What form? 



MED447 5-27 



Yes , the Division NBCE through the Med Bn via an NBC 4 (Nuclear) 
Report, and the parent medical group. Reporting interval would be specified 
in local SOP. 

5-23. SPECIAL SITUATION CONTINUED 

It is now 1900 hrs, two days later (approx H + 52 hrs) . The outside 
dose rate is 4 rad/hr which has been determined by IX Corps as an acceptable 
operat i ona I I eve I . 

5-24. SEVENTH REQUIREMENT 

a. What actions would you recommend to the CO to have the hospital 
become fully operational in the tent area? 

(U As radiological contamination is spread throughout the tent 
area, occupation of the tent area would require extensive decontamination to 
minimize and decrease the hazards from this remaining 4 rad/hr. Such actions 
would include shaking the tops of tents, brushing the tops and sides of tents 
and brushing and removing contaminants from items left in the open during the 
fallout; removing a small top layer of earth immediately around the tent area, 
say approximately 10m distance from any occupied location, and decontamination 
of vehicles, preferably at some other areas and with water. The tent area 
itself should be decontaminated preferably by dry methods. 

(2) Movement of unit to less contaminated area after maximum 
amount of decontamination has been accompi ished in the contaminated area prior 
to movement to clean area. This would include requesting assistance from the 
engineer battalion and any available decontamination teams within the division 
area . 

b. If the fallout had followed closely the predicted area what actions 
would you recommend to the CO at this time, and if concurrence is obtained, 
what actions would you take to implement such action? Explain. 

Recommend movement to support command area which is not within the 
fallout area. It will be recalled that this was the purpose of the CO ' s 
liaison visit to the division surgeon prior to the nuclear detonation. 
Naturally, request for such movement to new location would be coord i nated 
through the Med Bn and Med Gp. Attempts to decontaminate and minimize 
contained radiological contaminants within unit equipment prior to relocation 
in new position should be effected as cited in paragraph a above. Patients on 
hand should be evacuated prior to unit move. 



MED447 5-28 



EXERCISES, LESSON 5 

REQUIREMENT. The following exercises are to be answered by marking the 
lettered response that best answers the question; or by completing the 
incomplete statement; or by writing the answer in the space provided at the 
end of the question. 

After you have completed all the exercises, turn to "Solution to 
Exercises" at the end of the lesson, and check your answers with the 
sol ut ions. 

1. After a nuclear attack, which of the following sources of water is 
the LEAST safe? 

a. Water in canteens and water cans. 

b. Water from wells and springs. 

c. Water from streams. 

d. Water from lakes and ponds. 

2. Medical personnel and medical units generally will be faced with 
two primary problems when operating in a significant local fallout situation: 

a. Construction of shelters and evacuation of patients. 

b. Unit survival and performance of mission. 

c. Dispersion of unit and evaluation of hazards. 

d. Rotation of exposed personnel and evaluation of hazards. 

3. What is the most desirable method for the decontamination of 
veh ic les? 

a. Aging. 

b. Brushing. 

c. Washing with water and detergents. 

d. Washing with steam. 

e. Scrubbing with strong caustic solutions. 



MED447 5-29 



4. In addition to surface winds, the direction of fallout from ground 
zero is based upon: 

a . Height of burst . 

b. Yield of burst. 

c . W i nds aloft. 

d. Ambient temperatures. 

5. It is now 1000 hours, San Antonio time. What time is it, Greenwich 
Mean Time? 

a. 0800 hours. 

b. 1000 hours. 

c. 1600 hours. 

d. None of the above. 

6. The line in the Effective Wind Message which gives the day and time 
at which the winds were measured is: 

a. Alfa. 

b. Bravo. 

c . Char lie. 

d. Zulu. 

7. Letter item J of the NBC 1 report is the: 

a . Deve I op i ng c I oud . 

b. F I ash— to-bang time. 

c. Ground zero. 

d . W i nd d i rect i on . 



MED447 5-30 



8. The table on page A-37 of Appendix A, GR 76-332-100 gives a cioud 
radius of about km for a 100 KT nuclear weapon. 

a. 12. 

b. 8.1. 

c. 6.7. 

d. 3.8. 

9. If the outside dose rate of residual radiation is 100 rad/hr, the 
dose rate in a foxhole is rad/hr. 

a. 100. 

b. 10. 

c. 1 . 

d. .05. 

10. As shown on the map and overlay, the 98th CSH is in Zone I. Which 
of the following would represent a location for the hospital which would be 
outside Zone ! and Zone II? 

a. 366755. 

b. 352751. 

c. 350735. 

d. 380792. 

11. As shown on the map and overlay, what is the location of the 
nearest unit to ground zero of the nuclear detonation? 

a. 273861. 

b. 361758. 

c. 313457. 

d. 272823. 



MED447 5-31 



12. An illumination time of 10 seconds would indicate an approximate 
yield of KT . 

a. 125. 

b. 160. 

c. 200. 

d. 250. 

13. What is the downwind distance in kilometers of Zone I for a 100 KT 
weapon with an effective wind speed of 30 kmph? 

a. 20. 

b. 30. 

c. 40. 

d. 50. 

14. Which NBC (Nuclear) report would you use for immediate warning of 
expected contamination from a nuclear detonation? 

a. NBC 1 (Nuclear) report. 

b. NBC 2 (Nuclear) report. 

c. NBC 3 (Nuclear) report. 

d. NBC 5 (Nuclear) report. 

15. Which of the following represents tne distance from 36th Div hq to 
GZ on the over I ay? 

a. 3.4 km. 

b . 6 km . 

c . 1 2 km . 

d. 13 km. 









MED447 5-32 



16. Which of the following represents the correct formula for a 
transmission factor? 

a. TF = ID 

OD 

b. TF = OD 

ID 

c. TF = OD X ID 

d. TF = OD X ID 



17. In the effective wind message, what stands for the wind speed to 
the nearest kilometer per hour? 

a. sss. 

b. ttt. 

c. DD. 

d. ddd. 



MED447 5-3; 



SOLUTIONS TO EXERCISES, LESSON 5 

1 . d (para 5— 3a) 

2. b (para 5-2a, b) 

3. a (para 5-3c(2) ) 

4. c (para 5—5) 

5. c (para 5— 13a) 

6. d (Appendix A, p A-6 thru 8) 

7. b (Appendix A, p A-6 thru 8) 

8. c (Appendix A, p A-37) 

9. b (Appendix A, A-3) 

10. c (Map and overlay) 

11. a (Map and overlay) 

12. d (Append ix A, p A-33) 

13. c (Append ix A, p A-36) 

14. c (Appendix A, p A-6 thru 8) 

15. a (Map and overlay) 

16. a (para 5— 6c) 

17. a (para 5-8d(3) (b) ) 



MED447 5-34 



ACADEMY OF HEALTH SCIENCES 
PREVENTIVE MEDICINE DIVISION 
NUCLEAR, BIOLOGICAL, CHEMICAL SCIENCES BRANCH 




APPENDIX A GENERAL REFERENCE 
ON 
THE EFFECTS OF NUCLEAR, BIOLOGICAL AND CHEMICAL WEAPONS 



MED447 



A-i 



TABLE OF CONTENTS 



PAGE 

Radiation Dose Effect Relationship A- 1 

Correlation Factors A-2 

Transmission and Protection Factors A-3 

Rules of Thumb for Dose and Dose Rate A-4 

Half-Value Layer Thickness A-5 

Rad lation Shielding Equations A-5 

NBC Warning and Reporting System A— 6—1 1 

Fallout Decay Nomogram A- 1 2 

Total Dose Nomogram A-13 

Effect ive Downw i nd Message A- 1 4 

Chem i ca I Downw i nd Message A- 1 4—1 5 

Nucwarn A- 1 6 

Protection Requirements for Friendly Nuclear Strike A- 1 7 

Significance of Predicted Fallout Zones A- i 7 

Chemwarn A- 1 8 

Nuclear Radiation Degree of Risk Exposure A-19 

Radiation Status Category A- 20 

Field Radiac Equi pment A- 20 

Field Chemical Detection Equipment A-2 1 

Chemical Downwind Hazard Prediction A-22— 27 

Biological Downwind Hazard Prediction A-28— 30 

Fa I 'out Pred ict ions A-3 1-37 

Casua I ty CI asses A-38 

'Blast Damage, Surface Blast Nomogram A-39 

Blast Damage, Low Air Burst Nomogram A-40 

Thermal Radiation, Air and Surface Burst Nomogram A-41 

Combined Initial Nuclear Radiation Nomogram A-42 

G ' ossar v of Terms G-.1--1 1 



MED44 7 A-i i 





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MED447 



A-1 



CORRELATION FACTORS FOR RESIDUAL RADIATION 
(REF: GTA 3-6-3) 



ENVIRONMENTAL 
SHIELDING 

VEHICLES 
Ml Tank 
M60 Tank 



M2 IFV 
M3 CFV 

Ml 13 APC 



M109 SP howitzer 

M88 Recovery 

veh ic I e 
M577 Command 

post carr ier 
M551 Armored recon 

abn assault vehicle 



LOCATION OF 


CORRELATION 


SURVEY METER 


FACTOR 




20 


Turret, rear top 


25 


Turret, front 


53 


Chassis, near driver 


23 




9. 1 




9.1 



Directly in front of 
dr i ver on front wa I I 

Near f i rst squad 
member on left 
facing forward 

Near driver, left side 

Rear , r ight s ide 

Commander position 

Near driver, right side 

Rear, left side 

Near driver, right side 



3.6 



TRUCKS 

1/4-ton 
3/4-ton 
2-1/2-ton 
4-ton to 7-ton 



1 .3 

1 .7 
1 .7 
2 



STRUCTURES 

Mu 1 1 i -story bu i I d i ng 
Top floor 
Lower floor 



100 
10 



Frame house First floor 
Basement 



10 



UNDERGROUND SHELTER (3-foot earth cover) 
5,000 

FOXHOLES 



10 



MED447 



A-2 



TRANSMISSION & PROTECTION FACTORS FOR RESIDUAL RADIATION 

(REF: GTA 3-6-3) 



TF = IN / OUT 


IN 


= TF X OUT 


OUT = IN / 


TF 


PF = OUT / IN 


IN 


= OUT / PF 


OUT = PF X 


IN 


ENVIRONMENTAL 


TRANSMISSION 


PROTECTION 




SHIELDING 


FACTOR (TF) 


FACTOR (PF) 




VEHICLES 




Ml Tank 




0.04 


25 




M60 Tank 




0.2 


25 




M2 IFV 




0.2 


5 




M3 CFV 




0.2 


5 




Ml 13 APC 




0.3 


3.3 




M109 SP howi tzer 




0.2 


5 




M548 Cargo vehicle 




0.7 


1 .4 




M88 Recovery vehicle 




0.09 


1 1 M577 Command 


post 


carr ier 0.3 




3.3 






M551 Armored recon 










abn assault vehicle 




0.2 


5 




M728 Combat engr vehic 


e 


0.4 


20 




TRUCKS 










1/4-ton 




0.8 


1 .3 




3/4-ton 




0.6 


1 .7 




2-1/2-ton 




0.6 


1 .7 




4— ton to 7— ton 




0.5 


2 




STRUCTURES 










Mu 1 1 i-story bu i Id ing 










Top floor 




0.01 


100 




Lower floor 




0.1 


10 




Frame house 










F i rst f loor 




0.6 


1 .7 




Basement 




0.1 


10 




URBAN AREA ( in open) 




0.7 


1 .4 




WOODS 




0.8 


1 .3 




UNDERGROUND SHELTER 










(3-foot earth cover) 
FOXHOLES 




0.0002 
0.1 


5000 
10 





MED447 



A-3 



RULES OF THUMB - RESIDUAL RADIATION - DOSE AND DOSE RATE ESTIMATION 

(REF: TM 8-215, p 39) 

1 . The "Seven-Ten" Rule 

a. Used only for dose rate estimations. 

b. For every sevenfold increase in time, the dose rate is divided by 10 

c. Examples: 

(1) Ri = 1,000 rad/hr; R 7 = 100 rad/hr ; R* 9 = 10 rad/hr; R 3 «s = 1 
rad/hr . 

(2) R 3 = 50 rad/hr; RF 2 i = 5 rad/hr. 

d. This rule also works in reverse — R 2e = 15 rad/hr; R* = 150 rad/hr. 

2 . The "Doub I e-The-T ime" Rule . 

a. Used only for dose rate estimations. 

b. When time is doubled, the new dose rate may be found by dividing the 
old dose rate by two and subtracting ten percent of the result. 

c. Examples: 

(1) If the dose rate at H+1 (Ri) is 1,000 rad/hr, what will be the 
dose rate at H+2 (R 2 ) ? 

ANS: 1 .000 =500 
2 

10% of 500 = 50 

500 - 50 = 450 rad/hr at H+2 

(2) If the dose rate at H+1 is 1,000 rad/hr, what will be the dose 
rate at H+4 (R*)? 

ANS: Two twofold increases in time are involved. Dose rate at 
H+2 is 450 rad/hr (see 1 above). 

450 =225 
2 

10*/. of 225 = 23 

225-23 = 202 rad/hr at H+4 

(3) Working the rule in reverse is not algebraically correct. 

MED447 A-4 



The "Fit Forever" Rule 

a. Used only for total dose 

b. The rule is based on the formula D = F x I x T where 

(1) D = The total dose which would be received by an individual who 

stays forever at a location in a fallout area 

(2) F = A constant, five 

(3) I = The intensity or dose rate at that location at the time the 

exposure began. 

(4) T = The time in hours after the burst that the exposure began. 

c. Example — if an individual entered a fallout a ea at H+4 and the 
intensity at that location and at that time was 20 rad/hr, what total 
dose would he receive if he remained there indefinitely (forever)? 

D=Fx I xT=5x20x4= 400 rad total dose 



HALF-VALUE LAYER THICKNESS OF COMMON MATERIALS 

FOR FALLOUT RADIATION 

(Ref: TM 8.215, Table 13) 



STEEL 

CONCRETE 

EARTH 

WATER 

WOOD 



1 .8 cm 

5.6 cm 

8.4 cm 

12.2 cm 

22.4 cm 



0, 


,7 


in 


2. 


,2 


i n 


3. 


,3 


i n 


4. 


,8 


i n 



8.8 in 



RADIATION SHIELDING EQUATION 

R. = Ro / 2" or R = R. x 2 n 
Ri = Inside Radiation Dose Rate 
Ro = Outside Radiation Dose Rate 
n = Number of Half-Value Layers 



MED447 



A-5 



NBC WARNING AND REPORTING SYSTEM 
(Ref: FN! 3-3 w/ch 1) 



NOTE: 



NBC 1 (OBSERVE "S REPORT) 



LINE NUCLEAR 



NB062634 
90 Deg Gr id 
201405Z 



Aircraft 
Surface 



CHEMICAL 

LB200300 

201405Z 
201412Z 
LB206300 
Bomb I ets 
Nerve, V, 
Burst 



Est 



Air 



BIOLOGICAL 

LB200630 

200410Z 
200414Z 
LB206300 Act 
Aer ia I Spray 
Unknown 



60 sec 
15 Deg 



J 

L 

M 

Line items B 

be reported; 

informat ion 



, D, H, and either C or F should always 
other I ine items may be used if the 
is known. 



NBC 2 REPORT (EVALUATED DATA) 





_INE 


NUCLEAR 


CHEMICAL 


BIOLOGICAL 




A 


A024 


B002 


C001 




D 


201405Z 


200945Z 


201395Z 




F 


LB187486 Act 


LB126456 Act 


LB206300 Act 




G 


Ai rcraf t 


Bomb lets 


Unknown 




H 


Surface 


Nerve V. Air Burst 


Unknown 




N 


50 








Y 




0270 Deg, 015 km/h 


0270 deg, 015 km/h 




ZA 




518640 


518640 


NOTES: 1 


Th 


is report is normally based on two 


or more NBC 1 




re 


ports. It incl 


udes an attack locat 


ion and, in the 




case of a nuclear 


detonation, an eval 


uated yield. 


2 


Re 


fer to the chemical downwind messag 


e to determine 




could cover, significant weather phenomena, and air 




stabi 1 i ty . 






3 


L i nes that are f i 


1 1 ed in are necessar 


y for report (or 




if 


you know that 


information you must 


fill it in) . 






MED447 



A-6 



NOTES; 



NBC 3 REPORT (IMMEDIATE WARNING OF EXPECTED CONTAMINATION) 



Y 


02720312 


Z 


01902505 


2A 




Zl 


010, 0017, 




0028, 007 



LINE 


NUCLEAR 
A024 




CHEMICAL 
B002 




A 




D 


201405Z 




201415Z 




F 


LB187486 


Est 


LB560750 


<\ct 


H 






Nerve, V, 


Air Burst 


N 


50 








PA 






LB556751 
LB559754 
LB632774 
LB610794 
LB 58747 




PB 






In attack 
In hazard 


area 2—4 days 
area 1-2 days 


Y 


02720312 




0270 Deg, 


015 km/h 



518640 



If the effective windspeed is less than 8 km/h, line Z of the NBC 

3 (nuclear) consists of three digits for the radius of Zone I. 

If the windspeed is less than 10 km/h, line PA of the NBC 3 

(chemical) is 010, which is the radius of the hazard area. 

Line Z I is used only for NUCWARN reports. When line Z I is used, 

I i ne Z is not used . 

Line A,D,F,Y, and Z must be completed for Nuclear and A.D.F.H, 

PA.PB (if ground contamination is present)m y, and Z for chemical 





1 


VBC 4 REPORT (RECONNAISSANCE, MONITORING, AND SURVEY RESULTS) 






LINE NUCLEAR CHEMICAL 






H Nerve, V 






Q LB123987 LB200300 , Liquid 






R 35 






S 201535Z 170610Z 


NOTES: 


1 


Line items H, Q, R, and S may be repeated as often as necessary. 




2 


Radiation dose rates are measured in the open, with the instrument 
1 meter above the ground. 




3 


In line R, descriptive words such as "initial," "peak," 
"increasing," "decreasing," "special," "series," "verification," 
or "summary" may be added, 




4 


H.Q. and S are mandatory for chemical and Q.R. and S for nuclear. 





MED447 



A-7 







NBC 5 REPORT 


(AREAS OF ACTUAL CONTAMINATION) 


LINE 




NUCLEAR 




CHEMICAL 


A 




A0012 




B005 


D 




200700Z 




200700Z 


F 










H 








Nerve, V, Air Burst 













R 










S 








201005Z 


T 
U 
V 




201505Z 




201110Z 




ND651445 










ND810510 










ND821459 










ND651455 






w 




ND604718 
ND991 86 
ND114420 
ND595007 






X 








ND206991 
ND201576 
ND200787 
ND206991 


NOTE: 1. 


This 


report is 


best 


sent as an overlay if time and the tactical 




si tu 


ation permits. 




2. 


Lines A,D,F,T 


or 0,R 


,U,V,W, and X are reported for Rad contaminator 




and 


A.D.H.S.T. 


and X 


for Chem Bio. 



NBC 6 REPORT (DETAILED INFORMATION ON CHEMICAL OR BIOLOGICAL ATTACKS) 



LINE CHEMICAL OR BIOLOGICAL 

A B001 

D 200945Z (May) 

E 200950Z (May) 

F LB200300, Act 

G Art i I lery 

H Nerve, v, Air Burst 

I 20 rounds 

K Mostly small houses and barns, elevation 600 meters 

M Attack received as counterfire, enemy bypassed on right flank of 

attack area 

Q Liquid ground sample taken by detection team in attack area 

S 201005Z (May) 

T 201110Z (May) 

X As per overlay 

Y Downwind direction 0090 degrees, windspeed 010 km/h 

ZB This is the only chemical attack to in our area to date 

NOTES: 1. This report is submitted only when requested. 

2. This report is completed by battalion and higher NBC personnel. It 
is in narrative form, giving as much detailed information as 
possible for each I ine item. 



MED447 



A-8 



MEANING OF LINE ITEMS IN NBC REPORTS 
(Ref: FM 3-3 w/ch 1, Table 2-1) 



LINE 



NUCLEAR 



CHEMICAL AND 
BIOLOGICAL 



REMARKS 



Str ike ser i a 
number . 



Str ike ser ia 
number . 



Assigned by division 
NBC Center . 



Pos i t ion of 
observer . 



Position of 
observer . 



Use grid coordinates 
(or pi ace) . 



Direction of attack 
from observer . 



D i rect ion of 
attack from 
observer . 



Direction measured 
clockwise from grid 
north or magnetic north 
state which) in degrees 
or mils (state which). 



Date— time group 
for detonation. 



Date— time group 
for start of attack 



Zu I u t ime. 



I luminat ion t ime 



Date— time group 
for end of attack. 



seconds. 



Location of area 
attacked. 



Means of del ivery , 



Location of area 
attacked . 
name. 

Kind of attack. 



Use grid coordinates 
(UTM) or place 
State whether location is 
actual or estimated. 
State whether attack was 
by artillery, mortars, 
mu 1 1 i p I e rockets, 
miss i I es, bombs, or 
spray. 



Type of burst 



Type of agent/type 

of burst. 

P (persistent) 

NP (non-persistent) 



Estimate height of burst. 
Specify air, surface, or 
unknown for nuclear. 
State whether it was a 
ground or air burst or 
spray attack for 
chemica I . 



NA 



Number of munitions 
or aircraft. 



I f known. 



J F I ash— to— bang time 

K Crater present or 
absent and 
d iameter . 



NA 

Descr ipt ion of 
terrain and 
vegetat ion. 



Use seconds. 

Nuclear: Send in meters, 
Chemical : Sent in NBC 6. 



MED447 



A-9 



MEANING OF LINE ITEMS IN NBC REPORTS (CONT) 
(Ref: FM 3-3 w/ch 1, Table 2-1) 



LINE 



NUCLEAR 



CHEMICAL AND 
BIOLOGICAL 



REMARKS 



Cloud width at 
H+5. min. 



NA 



State whether measured 
i n degrees or mils. 



Stab i I i zed cou Id 
top or bottom angle 
or cloud top or 
bottom height at 
H+10. min. 



Enemy action before 
and after attack. 
Effect on troops. 



Nuclear: State whether 
angle is measured in 
degrees or mils, or 
whether height is measured 
in meter or feet, and if 
cloud top or bottom. 
Chemical : Sent in NBC 6. 



N 


Estimated yield 


NA 





Date— time group 
for contour 1 i nes. 


NA 


P 


Radar purposes 
onl y. 


NA 


A 


Coordinates of 


Predicated hazard 




external contours 


area. 



of radioactive 
c I oud . 



Sent as KT . 

Used when contours are 
not plotted at H+1 . 



Chemical: If windspeed is 
10 km/h or less, this item 
is 010 (the radius of the 
hazard area i n km) . 



PB Downwind direction 
of radioactive 
c loud . 



Duration of hazard. 



Nuclear: State whether 

direction is in degrees or 

mils. 

Chemica I : In days. 



Location of 
read i ng . 



Location of sampling Chemical: State whether 
and type of sample. test was air or liquid. 



Dose rate or actual 
value of decay 
exponent 



NA 



State in cGy/h. See 
sample NBC 4 for terms 
associated with this line 



Date— time group 
of reading. 



Date— time group 
contami nat ion 
detected. 



State time initial indent- 
ification test sample or 
reading was taken. 



H+1 date-time 
group, (hours) 



Date-time group of NBC 5 and NBC 6 reports 
latest contamination only, 
survey of the area. 



MED447 



A- 10 



LINE 



MEANING OF LINE ITEMS IN NBC REPORTS (CONT) 
(Ref: FM 3-3 w/ch 1, Table 2-1) 



NUCLEAR 



CHEMICAL AND 
BIOLOGICAL 



REMARKS 



1000-cGy/h. 
contour I ine. 



NA 



Plot in red 



300-cGy/h contour 
I ine. 



NA 



Plot in green 



W 100-cG/h contour 
I i ne. 



NA 



Plot in bl ue 



20-cGy/h 
contour I i ne . 

Direct ion of I eft 
and r i ght ad ia I 
I i nes. 



Area of actual 
contami nat ion. 

Downwind direction 
of hazard and wind- 
speed. 



Plot in black for nuclear, 
yellow for chemical. 

Di rect ion: 4 d ig i ts 
(degrees or mils). 
Wi ndspeed : 3 d ig i ts 
(km/h or knots) . 



Effect i ve wi nd 
speed . 

Downwind distance 
of Zone I . CI oud 
rad ius. 



NA 



3 digits (km/h or knots). 

3 d ig i ts (km or Num) . 

2 d i g i ts (km or Num) . 
If windspeed is less than 
8 km/h, this line contains 
only the 3— digit radius of 
Zone I . 



ZA 



ZB 



Zl 



NA 



NA 



Effect i ve wi nd 
speed . 

Downwind distance 
of Zone I . 
Downwind distance 
of Zone I I . 
Cloud radius. 



Significant weather 
phenomena. 

Remarks. 



NA 



See CDM for explanation of 
codes. 

Include any additional 
informat ion 

3 d igi ts (km/h) . 

4 digits (hundreds of 
meters) . 

4 digits (hundreds of 
meters) . 

3 d ig i ts (hundreds of 
meters) . 



MED447 



A- 11 



CENTIQRAY 
PER HOUR 
"t 

p- 10.000 

hVffl 

— «.000 

— S.000 

— 4.000 

3.000 

— 2.000 



=3 1.000 

-100 
700 
—600 
—600 

— 400 

— 300 

— 200 



r;100 

— 60 

— 70 
^O 

— 60 
—40 

—30 

— 20 



— 10 

— 6 

— 7 
6 

— 8 

— 4 

— 3 

— 2 



•— 1 



FALLOUT DECAY NOMOGRAM 
nsl.2 



CENTN3RAY 
PER HOUR 

"1 

1—1 



2 — 



TIME 
(HOURS AFTER BURST) 

n = 1.2 
i- 



3- 



100- 



6- 

7- 
J — 

16- 

28- 

40- 
60- 
60- 



h4 

6 
-8 



200- 



-2 



-10 



20 
30 

-60 

70 
-90 



160 



-300 



3 — 

4 — 
6 — 

6 — 

7 — 

8 — 

10 — 



20-R 

30 

40 

60- 
30- 
70- 
80- 

100^ 



200— 

300 — 

400 
600 
600- 
700- 

800- 

1.000 : 



2,000 — 

3.000 — 

4.000- 
6.000- 
6.000- 
7.000- 
6.000- 

10,000- 



MED447 



A- 12 






TOTAL 0O8E 
(D) 

10 -T- 

20-lJ- 
-I--30 



eoo- r 

800? 
UXO 



DOSE RATE 

(R,) 
1-r 



2-- 



60 

eo J - 

- -70 
100-- 



-r1«0 
200-^r 

- -300 

400- - 



4-J- 

• ■ 
8 

10 : 

20-- 



eo 

80- 
100 



200- - 



400-$- 
800 : 

8oo; 

1,000 



--30 



TOTAL DOSE (FALLOUT) 

n«l.2 

MOEX 

8-r 

--7 
8-- 

ir 5 

*-.r 
-.7* 

2-.'r 



70 
90 



--300 



800 

700 
rOOO 



2J0OO-- 



4JD00-Jr 

8JX» : 
6JX0- 

iajooo : 



600 

700 
900 



- r 3jD00 



6JDO0 
7,000 

ftjOOO 



2-.T 



^DOO^j- 

joooil- 

-= L 6jM0 



ENTRY TIME <T # ) 
(HOURS AFTER BURST) 
-26 



:rW 



--.7 
J8-- 

A-.r 



STAY TIME (T») 
(HOURS) 



** V* 4 



.16 

j08-r 
--J07 

J08-F- 

J06 

XM-.r 

--sa 
sn-'-r 

— Die 
JOli 




IF T« >H*26 HRS. 
D - R T IT, 




MED447 



A- 13 



NBC WEATHER/WIND MESSAGES 



Effective Downwind Message (EDM) 
(Ref: FM 3-3 w/ch 1, Appendix E) 



ZULU 


DDTTTT DATE-TIME GROUP WINDS W 


ALFA 


dddsss Over 


thru 2 KT 


BRAVO 


dddsss Over 


2 thru 5 KT 


CHARLIE 


dddsss Over 


5 thru 30 KT 


DELTA 


dddsss Over 


30 thru 100 KT 


ECHO 


dddsss Over 


100 thru 300 KT 


FOXTROT 


dddsss Over 


300 thru 1 MT 


GOLF 


dddsss Over 


1 thru 3 MT 



NOTES: 1. The first three digits (ddd) give the effective wind direction, in 
degrees, from grid north. 

2. The second three digits (sss) give the effective wind speed in 
kilometers per hour. 

3. The last three digits ( ) give the expanded angle in degrees. 

(only used if fan is greater than 40 degrees) 



Chemical Downwind Message (CDM) 
(Ref: FM 3-3 w/ch 1, Appendix M) 



1 10500 Zulu 
I Corps 
WHISKEY 
XRAY 
YANKEE 



110600 Zulu 

120010 418742 

125919 416742 

130005 518642 



NOTES: 1. CDM is only valid for 6 hours. 

2. Area affected may be a mapsheet number or an area such as I CORPS. 

3. Lines WHISKEY, XRAY, and YANKEE each contain coded weather 
information. Line WHISKEY is only valid for the first two hours, 
line XRAY for the next two hours, and line YANKEE for the last two 
hours . 

4. The upper left-hand date/time group of the CDM message, in this 
case "110500," reflects the latest date/time up through which 
pertinent weather data was used to compile the message. 

5. The upper right— hand date/time group of the CDM message, in this 
case "110600," is the date/time at which the message becomes 

ef feet i ve . 



MED447 



A- 14 



HOW TO READ THE CODED WEATHER INFORMATION IN A CHEM I CAI_' DOWNW I ND MESSAGE 

(Ref: FM 3-3 w/ch 1, Figure M-2) 



WHISKEY: 



120 010 



05 



1 









EFFECTIVE DOWNWIND 
DIRECTION IN DEGREES 








EFFECTIVE DOWNWIND 
SPEED IN KM/H 









AIR STABILITY 




CODE 


Very Unstable 


(U) 


= 




] 


Unstab I e 


CO) 


= 


2 


SI ighti.y Unstable 


(U) 


= 


3 


Neutra ! 


(N) 


= 


4 


SI ightly Stable 


(S) 


r 


5 


Stable 


(S) 


= 


6 


Very Stabie 


(S) 


= 


7 



TEMPERATURE 




CODE 
05 


5°C 


4°C 


= 


04 


3°C 


= 


03 


2°C 


= 


02 


l°C 


= 


01 


0°C 


= 


00 


-1°C 


= 


51 


-2°C 


= 


52 


-3°C 


= 


53 


-4°C 


= 


54 


-5°C 


= 


55 



CODE CLOUD COVER 

= Sky less than half 
covered by clouds 

1 = Hal f the sky 

covered by clouds 

2 = More than hal f the 

sky covered by 
c I ouds 



I 








* 


SIGNIFICANT WEATHER 


CODE 
3 


= 


PHENOMENA 


Blowing snow or sand 


4 




Fog, ice, fog, or 
thick haze 
(visibility < 4 km) 


5 


= 


Dr i 22 1 e 


6 


= 


Ra i n 


7 


= 


Light rain or snow 


8 


= 


Showers of rain, snow, 
ha i 1 or a mixture 


9 


= 


Thunderstorm 




The significant weather code can also be written as a dash (— ) if the 
weather is clear or unknown. 



MED447 



A- 15 



NUCWARN (FRIENDLY NUCLEAR STRIKE) 
(Ref: FM 3-3 w/ch 1, Table 2-2) 



LINE 


MULTIPLE 


SINGLE 


A 


Lamp Post 


AC002 


D 


162025Z-162155Z 


270915Z-2709302 


F2 


PA6 13423 
PA616515 
PA655523 
PA631450 
PA625413 




F3 


PA602403 
PA605536 
PA672552 
PA642472 
PA673442 


011 PA215154 


H 

1 


3 Surface 
22 


Surface 



L i ne/Letter Mean i ng Remarks 

A Target number of code. Use target number such as AF001 single 

attack. Use code such as Hot Candle, 

for multiple attacks. 
D Date— time groups. Single: Date and time attack will 

begin and the date and time attack 

will be cance I I ed . 

Multiple: Date and time attack will 

begin and date and time when all 

bursts will be complete. This line 

should be encoded. 
F1 Minimum safe distance 1 Single: MSD in hundreds of meters 

(MSD 1) and location of followed by UTM grid coordinates of GZ 
single or multiple attack, or DGZ will be included only in the 

first Foxtrot line sent). 

Multiple: UTM grid coordinates of 

MSD1 box. 
F2 MSD 2. Same as F1 except information pertains 

to MSD 2. 
F3 MSD 3. Same as F1 except information pertains 

to MSD 3. 
H Type burst and number of If there is any chance that the strike 
bursts, (surface or sub— will be a surface or subsurface 
surface only) burst this line is sent. 

I Number of bursts. For multiple bursts only. 



MED447 A- 16 



PROTECTION REQUIREMENTS FOR FRIENDLY NUCLEAR STRIKE 
(Ref: FM 3-3 w/ch 1, Table 2-3) 



Area 



Limit of Negligible Zone of 
Risk to: Warn i ng 



Protect ion 
Requ i rement 



DGZ to MSD 1 (F1) 



MSD 1 to MSD 2 Warned, protected 
(F1 to F2) personnel . 



MSD 2 to MSD 3 Warned, exposed 
(F2 to F3) personne I . 



MSD 3 and Unwarned, exposed 

beyond personne I . 

(F3 to beyond) 



1 Evacuate all personnel 

2 Personnel in buttoned up 

tanks or foxholes with 
overhead cover. 

3 Personnel are prone on 

ground with all skin area 
covered . 

No protective measures 

except dazzle and EMP. 



SIGNIFICANCE OF PREDICTED FALLOUT ZONES 
Exposed, unprotected people may receive the following doses from fallout 
Zone I 



Zone 



Immediate operational concern 
More than 150 cGy within 4 hours 

Secondary hazard. 

Less than 150 cGy within 4 hours 

More than 50 gGy within 24 hours 



Outside the predicted area 

No more than 50 cGy in 24 hours 

No more than 150 cGy for an indefinite period 



MED447 



A- 17 



CHEMWARN (FRIENDLY CHEMICAL STRIKE) 
(Ret: FM 3-3 w/ch 1, Table 2-4) 



A 


AF002Chem 


D 


020830 


F 


PG 560750 


G 


Artillery Ground Burst 


H 


Persistent Nerve 


PA 


PG 556751 




PG 559754 




PG 632774 




PG 610694 




PG 558747 


PB 


In Attack Area 2—4 days 




In Hazard Area 1 — 2 days 


Y 


0015 Deg, 15 km/h 



NOTE: A CHEMWARN message is plotted like an NBC 3 (chemical) report 

CHEMWARN FORMAT 



Li ne/Letter 



Mean i ng 



Remarks 



G 

H 

PA 



PB 
Y 



Strike serial number or code 

chemical attack. 

Date— time group of attack. 



Location of attack, 



De I i very means, 
Type of agent. 



Attack Area and predicated 
hazard area. 



Duration of hazard 
Downwind direction 
and wind speed. 



Indicate that this is a word. 

Only the date and time of the 
attack is given. This should 
be encoded . 

Grid coordinates of center of 
attack. If attack is spread 
over large area, a series of 
coordinates may be given to 
indicate the center of mass 
of the attack. This should 
be encoded. 

Tel I how del ivered and how 
d issemi nated . 
CI ass i f y agent by 
physiological effect and 
duration of effectiveness. 
When wind speeds are 10 km/h 
or less, this I i ne will be 
010, (the radius of hazard 
area is in km). When wind 
speeds are higher than 10 
km/h, 6— d i g i t coordinates 
will be g i ven . 
In days. 

Downwind direction: 4 digits 
in degrees or mils (state 
which). Windspeed: 3 digits 
in km/h only. 



MED447 



A- 18 



NUCLEAR RADIATION DEGREE OF RISK EXPOSURE 
(Ref: FM 3-3 w/ch 1, Table J-2) 



OEG = Degree of Risk — Prior Exposure OR 

OEG = Degree of Risk — Average Value for RES Category 



Total Cumulative Dose 
(cGy) before exposure 


RES 
Category 


Average Value for RES Category 


No exposure 


RES-0 


cGY 


Some exposure but not 
greater than 70 


RES-1 


40 cGy 


Greater than 70 but 
less than or equal 
to 150 


RES-2 


110 cGy 


Greater than 150 


RES-3 


Greater than 150 cGy 



Single Exposure Criteria 



Negligible Risk: 50 cGy 
Moderate Risk : 70 cGy 
Emergency Risk : 150 cGy 



MED447 



A- 19 



BATTALION OR COMPANY RADIATION STATUS CATEGORY 
(Ref: FM 3-3 w/ch 1, Table J-3) 



BATTALION 
OR COMPANY 
RS CATEGORY 

RS-0 
RS-1 
RS-2 
RS-3 


NUMBERS OF COMPANIES IN BATTALION OR PLATOONS IN COMPANY 
2 3 4 5 6 7 


SUM OF RS NUMBERS OF ALL PLATOONS OR COMPANIES 


0-1 0-1 0-2 0-2 0-3 


1-2 2-4 2-5 3-7 3-8 4-10 


3 


-4 5-7 6-9 8-12 9-14 11-17 


5 


-6 8-9 10-12 13-15 15-18 18-21 



FIELD RAD I AC INSTRUMENTS 



I nstrument 
IM 9/PD 

IM 93 UD 

IM 147/PD 

PP 1578A/PD 

AN/PDR 27 

IM 174A/PD 
DT 236 

AN/VDR 2 



Use 

CI i n ica I 
Dos imeter 

Tact i ca I 
Dos imeter 

NBC Team 
Dos imeter 

Dosimeter Charger 
IM 9, IM 93, and 
IM 147 

Personnel and 

Equ i pment Survey 

Area Survey 

Tactical Dosimeter 
(Wristwatch Design) 

Personnel and 
Equ i pment Survey 



Measures 



Gamma Dose 



Gamma Dose 



Gamma Dose 



Range 

0—200 mi I I i roentgen 

0—600 roentgen 

0—50 roentgen 



Gamma Dose Rate 0-500 

mi I I i roentgen/hour 
Detects Beta over four scales 

Gamma Dose Rate 0-500 rad/hour 



Neutron and 
Gamma Dose 



0-1000 rads 



Gamma Dose/rate 1-1000 rad/hr 
Beta Detection 



MED447 



A-20 



FIELD CHEMICAL DETECTION EQUIPMENT 



Detection Equipment Ident i f i es Reaction Time 

Paper, Chem Agent Nerve & Blister Liquid Few seconds to 1 minute 
Detector, VGH, 
ABC - M-8 

Paper, Chem Agent Liquid Agents Few seconds 

Detector, M-9 

Detector Kit, Chem Nerve, Blood, Blister 16 minutes 
Agent, M256 Vapor 

H20 Testing Kit, Blood, Blister, Nerve 10 minutes 
Chem Agent, M272 



Chemical Agent Nerve, Blister Vapor 

Monitor (CAM) 

M8A1 Automatic Nerve, Vapor Few seconds 

Chemical Agent Alarm 



MED447 A-21 



CHEMICAL DOWNWIND HAZARD PREDICTION 

DETERMINATION OF ATTACK TYPE AND CASE 
(Ref: FM 3-3 w/ch 1, Table N-1 ) 



TYPE 
ATTACK # 


CASE 


ATTACK AREA 


WIND SPEED 


DOWNW I ND 
HAZARD 


AIR (A) 
(vapor) 


a 
b 


1 km 
1 km 


< 10 km/h 
> 10 km/h 


10 km circle 

10, 15, 30 or 

50 km *** 


GROUND 
(B)#* 
(I iqu id) 


a 
b 
c 
d 


< 1 km 

> 1 km to < 2 km 

> 2 km d istance 
same as case 

a , b, or c 


> 10 km/h 

> 10 km/h 

> 10 km/h 
< 10 km/h 


10 km 
10 km 
10 km 
10 km circle 



* Assume attacks to be Type A unless there is unmistakable evidence of 
ground contamination. 

** If the size of the attack area is not known the attack will be assumed 
to by Type B, case b. 

#*# Downwind hazard depends of the means of delivery and temperature 
grad i ent 



NOTES: 1. Examples of air contaminating (non-persistent) agents are 
Blood (AC, CK) , Nerve (G series), and Choking (CG) . 
2. Examples of ground contaminating (persistent) agents are: 
Blister (H series, L, CX) and Nerve (V, TGD) 



MED447 



A-22 



CHEMICAL HAZARD PLOTTING STEPS 
(Ref: FM 3-3 w/ch 1, Appendix N) 

Procedure: 

Type A. Case a 

1. Plot attack location. 

2. Draw a 1 km radius circle, label as "attack area". 

3. Draw 10 km radius circle, label as "hazard area". 

4. Send NBC 3 (Chem) . 
Type A. Case b 

1. Plot attack location. 

2. Draw grid north line. 

3. Draw 1 km radius circle, label as "attack area." 

4. Draw a line from attack center in the downwind direction (from CDM) . 

5. Extract hazard distance from table. Plot downwind distance and draw a 
line perpendicular to the downwind direction. 

6. Extend downwind line 2 km upwind from the attack center. Draw tangent 
lines from this point, label as "hazard area". 

7. Send NBC 3 (Chem) . 
Type B, Case a 

1. Plot as type A, case b. The maximum downwind hazard distance is 10km. 

Type B, Case b 

1. Plot attack location. 

2. Draw grid north line. 

3. Draw a 2 km radius circle, label as "attack area". 

4. Draw a line from attack center in the downwind direction (from CDM) 10 
km. Draw a line perpendicular to the downwind direction. 



MED447 A-23 



5. Extend downwind I ine 4 km upwind from the center of the attack 
location. Draw tangent lines from this point, label as "hazard area". 

6. Send NBC 3 (Chem) . 
Type B, Case c 

1. Plot attack area. Identify a point at each extreme end. 

2. Draw a 1 km circle around each point. 

3. Draw a downwind direction line 10 km from the most downwind circle. 
Draw a short line downwind from the other point, label as "attack 
area". Extend both lines 2 km upwind. 

4. Draw a line perpend i cu I ar to the downwi nd direction line... 

5. Draw tangent lines, label as "hazard area". 

6. Send NBC 3 (Chem) . 
Type B, Case d 

1. Derive the attack location from an NBC 1 or NBC 2 report and plot the 
location on a map or template. 

2. Draw a 10 kilometer radius circle around the attack area center, label 
as "hazard area" . 

3. Draw the appropriate radius around the center of attack as per means 
of delivery, label as "attack area". 

4. Send an NBC 3 (Chem) to un i ts/ i nstal I at ions in the hazard area. 



MED447 A-24 



TABLES FOR USE IN CHEMICAL DOWNWIND HAZARD PREDICTION 



TABLE 1 

AIR STABILITY CATEGORY 

BASIC CHART 

(Ref: FM 3-3 w/ch 1, Fig. M-3) 



m 


CONDITION OF SKY 




TIME OF DAY AND 


Less than 


More than 




ANGLE OF SUN 


ha I f covered 


ha I f covered 


Overcast 


M <4° 


S 


S 


N 











R >4° and <32° 


N 


N 


N 


N 








I >32° and <40° 


U 


N 


N 


N 








G >40° 


U 


U 


N 


>46° 


U 


U 


N 


E 








V >35° and <46° 


U 


N 


N 


E 








N >12° and <35° 
i 


N 


N 


N 


i 

N >5° and <12° 


S 


N 


N 


G 








<5° 


S 


S 


N 



NOTE: The Stability Category found in this Table must be adjusted 
to conditions of weather and terrain by using Table 2. 



MED447 



A-25 



STABILITY CATEGORY ADJUSTMENT 
(Ref: FM 3-3 w/ch 1, Fig. M-4) 

TABLE 2 



AIR STABILITY CATEGORY 
ADJUSTMENT CHART 


WEATHER AND TERRAIN 

AM eight conditions given below 
must be checked. If more than one 
applies, choose the most stable 
category. 


STABILITY CATEGORY 
FROM 
BASIC CHART 


U 


N 


S 


Dry to slightly moist surface 


U 


N 


S 


Wet surface 

(e.g., after continuous rain or dew) 


N 


N 


S 


Frozen surface or partly covered 
with snow, frost, or hoarfrost 


N 


S 


S 


Surface completely covered with snow 


S 


S 


S 


Cont i nuous ra i nfal I 


N 


N 


N 


Haze or mist (visibility 1—4 km) 


N 


N 


S 


Fog (visibility less than 1 km) 


N 


S 


S 


Downwind speed more than 18 km 


N 


N 


N 


NOTES: 1. Table 2 is used for adjustment of the stability category 
found from Table 1, taking into account influences of 
surface and weather. 
2. All eight conditions of terrain and weather listed in Table 
2 must be checked, and, in case of doubt, the most stable 
category is to be chosen. 



MED447 



A-26 



TYPE "A" ATTACK 
(Ref: FM 3-3 w/ch 1, Table N-2) 

DOWNWIND DISTANCE OF HAZARD AREA 

TABLE 3 



Means of De I i very 



Artillery, Bomblets, and 
Mortars 

Multiple Rocket Launchers, 
Missiles, Bombs, and 
Unknown Mun i t i ons 



Distance from center of attack 
area along downwind axis, when 
the air stability category is: 



U 



N 



10 km 



15 km 



30 km 



30 Km 



50 km 



50 km 



NOTE: When no information is available on the nature of the munitions used 
in the attack, use the figures given for multiple rocket launchers, 
missiles and bombs. 



TYPE "B" ATTACK 
(Ref: FM 3-3 w/ch 1, Table N-3) 

PROBABLE TIME AFTER GROUND CONTAMINATION 
WHEN PERSONNEL MAY SAFELY REMOVE MASKS 



TABLE 4 



Daily Mean Surface Air 
Temperature 



Wi th i n Attack Area 
(number of days) 



Wi th i n Hazard Area 
(number of days 



<0° - 10°C (32-50°F) 
11° - 20°C (51-68°F) 
21° - >30°C (69-86°F) 



3 to 10 days 
2 to 4 days 
up to 2 days 



2 to 6 days 
1 to 2 days 
up to 1 day 



NOTE: Tests for presence of chemical agent contamination and/or proper 
unmasking procedures must a I ways be used before unmasking after a 
chemical attack or in any area where a chemical agent hazard might 
ex ist . 

NOTES: 1. The estimates assume ground contamination densities of up to 10 
g/m 2 . 

2. In making hazard estimates, vapor has been considered to be the 
determining factor within the attack area as well as in the 
downwind hazard area, however, the duration of hazard from 
contact with bare skin is difficult to predict. Duration can 
only be determined by the use of chemical agent detection or 
confirmation devices. 

3. When temperatures are consistently low, the duration of ground 
contamination may be longer than indicated in the Table. The 
absence of vapors does not preclude the presence of contamination 

4. Daily, mean, surface air temperature may be obtained from the 
local meteorology (MET) officers. 



MED447 



A-27 



BIOLOGICAL DOWNWIND HAZARD PREDICTION 



CLOUD DURATION OF GREATEST EFFECTS IN ZONE I* 
(Ref: FC 3-3-2) 



Type 


C 1 oud durat i on 


Pathogens, Hardened (engineered or spore) 


8 hours 


Pathogens, Non— hardened ** 


Number of hours from time 
of attack to BMNT + 2 hrs 
(max of 8 hours) 
(min of 2 hours) 


Tox i ns 


8 hours 



* The actual effectiveness to minimum hazard levels may extend to as 
much as 32 hours, or four (4) times the cloud duration of greatest 
effects (4 X 8 = 32) . 

** If a Biological Agent is delivered after BMNT and prior to that day's 
sunset it is automatically treated as a hardened pathogen with an 8 
hour cloud duration. 



MAXIMUM DOWNWIND HAZARD DISTANCE (MDWHD) : 
MDWHD = 4 X wind speed (km/hr) X cloud duration of greatest effects. 



(Te.r) 



TIME OF CLOUD ARRIVAL (T a .r): 

= Time of attack + Distance from attack area (km) 

Wind speed (km/hr) 



TIME OF CLOUD EXPOSURE (To.,): 

(To.x) : = Distance from attack area (km) 
3 X Wind speed (km/hr) 



MED447 



A-28 



DETERMINATION OF ATTACK TYPE AND CASE 

BIOLOGICAL HAZARD PREDICTION 
(Ref: FC 3-3-2) 



Hazard 


Attack Type 


Type 


Case 


Aeroso 1 

(air contaminating) 


Po i nt or Area of 
Attack 


A 


a 


Spray Line Attack 


A 


b 


Large L iqu id Drops 
(ground contam- 
i nat i ng) 


NA 


B 


NA 



Procedure: Biological Hazard Plotting Steps 
Type A, case a 

1. Plot attack location. 

2. Draw a circle with a radius equal to the radius of the attack area 
plus 1 km (minimum radius of 1 km) 

3. Determine the MDWHD. 

4. Draw a line equal in length to the MDWHD from attack center toward 
the downwind direction (from CDM) . 

5. Draw a line perpendicular to the downwind direction which intersects 
the end-point of the MDWHD line. 

6. Extend the downwind line twice the radius of the circle upwind. 

7. Draw tangent lines from this upwind point. 

8. Divide the MDWHD by 4. Plot this distance along the MDWHD line: 
Draw a perpendicular at this point to define the Zone I endline. 

9. Send the NBC 3 (Bio) . 



MED447 



A-29 



Type A, case b 

1. Plot attack area. Identify a point at each extreme end. 

2. Draw a 1 km circle around each point. 

3. Determine the MDWHD. 

4. Draw a I i ne equal in length to the MDWHD from the center of the most 
downwind circle toward the downwind direction. 

5. Draw a line perpendicular to the downwind direction which intersects 
the endpoint of the MDWHD line. 

6. Draw a short downwind line from the most upwind circle. 

7. Extend both downwind lines 2 km upwind. 

8. Draw tangent lines form these upwind points. 

9. Divide the MDWHD by 4. Plot this distance along the MDWHD line. Draw 
a perpendicular at this point to define the Zone I endline. 

10. Send the NBC 3 (Bio) . 

Type B 

1. Plot attack location. 

2. Draw a circle with a radius equal to the radius of the attack area plus 
1 km (minimum radius of 5 km). 

3. Send the NBC 3 (Bio) . 



MEANING OF ZONES FOR BIOLOGICAL AREAS 

Zone I — more than 20—30*/. casualties. 

Zone II — 20—30'/. casualties, gradually decreasing to 1—3'/.. 

Outside the predicted area — no more than 1—3% casualties. The biological 
hazard is no greater than normal. 



MED447 A-30 



FALLOUT PREDICTION 
(Ref: FM 3-3) 

1. Simplified Fallout Prediction 

a. Locate GZ and identify DTG 

b. Determine yield (illumination time, cloud— top or bottom angle versus 
f I ash— to— bang time, or f I ash— to— bang time versus cloud width, pp. 33, 
34, 35) 

c. Determine wind data from current effective downwind message 

d. Determine Zone I and Zone II (pp. 36) 

e. Determine cloud radius (pp. 37) 

f. Plot parameters 

(1) Wind direction azimuth 

(2) Fan 20 degrees either side of wind direction 

(3) H+1, H+2 time of arrival arcs 

(4) Zone I and Zone I I arcs 

(5) C I oud rad i us 

(6) Connect Zone I arc tangent to cloud radius 

2. Detailed Fallout Prediction 

a. Located GZ and identify DTG 

b. Draw rad i a I I i nes 

c. Draw H+1, H+2 time of arrival arcs 

d. Draw Zone I and Zone I I arcs 

e. Draw cloud radius 

f. Connect Zone I arc tangent to cloud radius 

3. ANALYZE THE POTENTIAL EFFECT ON YOUR OPERATIONS 

MED447 A-31 






PREPARATION OF A DETAILED FALLOUT PREDICTION FROM THE NBC - 3 (NUCLEAR REPORT) 

(Ref: FM 3-3 w/ch 1, Appendix D, ) 



ALFA 
DELTA 



24 
240700Z 



MN34O670 (actual) 




Time-of-ArriTal Arcs: 
S«e Zulu Line. 



For I hr: 19 Kmpta X 1 hr = 19 Km 
For 2 hr: 19 Kmph X 2 hr = 38 Km 
Foe 3 hr: 19 Kmph X 3 hr = 57 Km 



A-32 



YIELD ESTIMATION VERSUS ILLUMINATION TIME 
(Ref: FM 3-3 w/ch 1, Table B-l ) 

Illumination Time 

(Seconds) Yield (KT) 

Less than 1 1 to 2 

1 2.5 

2 10 

3 22 

4 40 

5 60 

6 90 

7 125 

8 160 

9 200 
10 250 
12 325 
14 475 
16 700 



A-33 



YIELD ESTIMATION (FLASH TO BANG TIME VERSUS 

STABILIZED CLOUD TOP ANGLE OR STABILIZED CLOUD BOTTOM ANGLE) 

(Ref: FM 3-3 w/ch 1, Figure B-5) 




2 
O 

»- 

H 

o 

a 

o 

3 

o 

-i 
o 

I 

o 
-I 

UJ 



200- 



100=: 



60; 
40 : 

20 



10- 
9- 
8- 



2—^ 

1 - 
.8; 
.8- 



.4- 

.3- 

.2— A 



■10 
■8 

-8 
■8 

■4 



— 2 




-.20 



.10 
.08 

.08 
.05 
.04 
.03 

.02 



a 
O 

»- 

Q 
3 
O 



a 

UJ 



STABILIZED CLOUD-TOP 

OR CLOUD-BOTTOM 
ANGLE YIELD ESTIMATION 



1.400 - 



r— 80 



u. 
O 

2 
O 

*- 

o 

a 

a. 
O 

a 
O 



ui 
O 

z 
< 



1.000- 
900 
800- 
700 
800- 
600- 
400- 

300- 
200- 



100- 
90- 



h-70 ^ 


UJ 
UJ 

E 
O 

UJ 

h— 60 3 



70- 
60" 
50- 
40- 

30- 
20-^ 



60 



•40 



a 

3 
O 



30 ° 

u. 
O 

20 2 
O 



•10 

•8 
-7 

■6 

■5 

-4 

3 



O 

a 

cr 
O 
a. 
O 



UJ 

-j 
O 

z 
< 



6 

8 
7 
8 
9 
10 



20 



30 — 



» 
a 
z 
o 
o 

UJ 

2 40- 

Ul 

2 50- 



o 

z 
< 
o 

I 

o 

I- 

z 

(0 

< 



60- 
70- 
80- 
90- 
100." 



— 2 



— 3 



— 10 



200- 



300 — I 

400- 

500- 
600- 
700- 
800- 
900- 
1.000" 



.01 



20 



30 



— 40 



2 

O 

c 

UJ 
N 

a 
z 

3 

o 

E 
O 
i 

o 



UJ 

u 

z 
< 



a 
" 50 5 

-60 
-70 
-80 
-90 
•100 



■200 

•300 

-400 
500 



A-34 



YIELD ESTIMATION (FLASH TO BANG TIME VERSUS 

NUCLEAR BLAST CLOUD WIDTH AT FIVE MINUTES AFTER DETONATION) 

(Ref: FM 3-3 w/ch 1, Figure B-3) 



YIELD (KT) 
r— 10.000 

— 8.000 

— 6.000 

■ 4.000 
2,000 

^-1.000 

— 800 

— 800 

-400 
r— 200 



100 

80 

80 

40 



fe— 20 
10 

a 

8 



^-2 



.8 

.8 

— .4 



1-.1 
= .08 
— .08 



NUCLEAR BURST 

ANGULAR CLOUD 

YIELD ESTIMATION 



700 
600 
500 
400 

300 — 



~ 200 

a 



o 

e 
tu 

N 

a 

z 

3 

o 

cr 
a 



UJ 

O 

z 
< 

K 

2 
a 



100 

80 
70 
00 
50 



40 — 



c— 2.000 



-1.000 

-800 
•700 
-600 
-500 

-400 
■300 



30 



20- 



10 



co 

a 
z 
o 
o 

UJ 

■200 2 

tu 

2 



•100 

80 
■70 
■60 

50 



10 

8 

7 

'8 
■6 



a 

z 
< 

01 



I 

z 
■40 co 

< 

■30 i 



-20 



NUCLEAR BURST 

ANGULAR 

CLOUD WIOTH 

(8 MINUTES) 

(MILS) (DEGREES) 

9— r-0.8 
10 



— 1.0 



20 — 



30- 

40- 

50 — 

60 

70 
80 
00- 
100 — 



-5 
-6 

•7 

-8 
9 
10 



200—" 



300 



— .04 



20 



— .02 



400 — ' 



600 



A-35 



DOWNWIND DISTANCE OF ZONE I: ZONE OF IMMEDIATE OPERATIONAL CONCERN 
(Ref: FM 3-^ w/ch 1, Figure D-7) 



DOWNWIND DI3TANCE 
ZONE OF IMMEDIATE CONCERN 



ZONE I 

DOWNWIND DISTANCE 

SURFACE BURST 

Ml Km 

700 — , 



EFFECTIVE 
WIND SPEED 
Mph Kmph 
100=3 — 1«0 

60- 




. — 1.000 



■fc-600 
-400 
300 
260 
— 200 
:— 160 




YIELD 



T !^ 



o 

< 
O 
UJ 

a 



3- 

2.5- 

1.8- 



900 
700- 

600- 

300- 
260- 

160- 



O 

o 



2.2 

1.( 

.9- 
.7- 
.5- 



10 MT 



-800 
-800 

-400 
-200 



-1MT 




.3- 

2.5— f- 

.16 — 



.09- 
.07- 

.06- 

.03- 
.026-4- 

.015-- 



.8 
.8 

-.4 



-.08 
.08 

-.04 
-.02 



100KT 



-10KT* 



1 KT 



1 KT 



.01 KT 



YIELD 



A-36 



CLOUD RADIUS (STABILIZED AT H+10 MINUTES) 
(Ref: FM 3-3 w/ch 1, Figure D-3) 



YIELO 



CLOUD 
RADIUS 



YIELD 




30 — 



— 20 



— IE 



10 — 



5- 



«- 



— 10 

— 9 

— S 
7 
E 




h-2 
1.S 

\— 1-0 




A-37 







Tablt tl 


An 


• Bun 


—Fzp<ur4—16-tS KT (Cctualty CUuiet b» %) 












JUdiui 
60-160 m. 


K 


Ra 
Be 
W 


IU 
Bo 


Ra 
Bf 

W 


Ra 
B/ 


Ra 

W 


Ra 


Km 
Be 
W 


Rra 
Be 


Rra 
Bf 
W 


Km 
Bf 


Rm 
W 


Rm 


Bo 
W 


Bo 


Bf 
W 


Bf 


W 


Offset DIat. ^meters): 
0-460 


100 




































450-460 


70 


10 


20 
































460-1100 


10 


30 


60 
































1100-1400 


10 


15 


30 










16 


30 




















1400-1600 


10 


















10 


25 


6 


6 






10 


26 


6 


1600-1860 


10 






























20 


60 


10 


1860-2260 


































6 









TMe 17 


. Air 


Burtt 


— Ezpoted — 


16-15 KT (Catualty CTaw* by %) 












Radluj: 
460-650 m. 


K 


Ra 
Be 
W 


Ra 

Be 


Re 
Bf 
W 


Re 
Bf 


Ra 
W 


Ra 


Rm 
Bo 
W 


Rm 
Be 


Rm 
Bf 
W 


Rm 
Bf 


Rm 
W 


Rm 


Be 

W 


Be 


Bf 
W 


Bf 


w 


tfset DUl. (meters) : 
0-160 


86 


6 


10 
































160-250. 


80 


6 


16 
































250-360 


70 


10 


20 
































360-460 


60 


16 


26 
































460-660 


46 


20 


36 
































660-860 


20 


26 


60 












6 




















860-1100 


10 


25 


46 










6 


6 




6 












6 




1100-1400 


10 


16 


26 










6 


10 


6 


10 










6 


10 




1400-1600 


10 


6 


10 












6 


6 


10 










10 


30 


6 


1600-1860 


5 


5 


6 












6 




6 










16 


60 


A 


1860-2260 


5 






























10 


46 


6 


2250-2500 












. 






















10 





Casua I ty Symbo i s 

Ks — The casualty dies within 6 hours following the explosion. 

Rs — Severe ionizing radiation injury manifested by incapacitating signs and 

symptoms within 2—4 hours. Prognosis is guarded and high probability 

of fatal out come. 
Rm — Moderate ionizing radiation injury manifested by sign and symptoms 

which occur later than 5 to 6 hours following the explosion. The 

prognosis is favorable and there is a low probability of a fatal outcome 
Bf — Thermal burns, 2—3 degree on the face. 
Be - Thermal burns, 2-3 degree, occurring under clothing and affecting 

up to 25% of the body surface. 
W — Wounds, fractures, or other mechanical trauma. 



MED447 



A-38 



BLAST DAMAGE, SURFACE BLAST 



Yield 
(KT) 



H. (Meters) 



5.000 -- 
4.000 -- 

3.000 
2.000 "- 



1.000 
900 
,«00 
700 
600 

600 

400 



300 



inn 
90 
gO -- 

TO -- 

60 

60 "- 
40 -- 



30 



20 -- 



10 

9 
K 
7 

6 
6 ■ 

4 - 



3 -- 



Radius of Damage 
(Meters) 



50.000 - 




40.000 - 








30.000 : 





29.000 



Severe 
Damage Psi 



1-5. 



W>»d Frame Houses — 
Parked Aircraft - 
Bnck Apartment Huuifi 



4 
5 



Oil Storace Tanks _■ j 



Fixholes. Trenches - 
(Ci-ualticO 



n.ntrn a n ,J 
L'a-l^fF^jrJ Structure* 



10 



15 

:o 

(■ 25 
30 

40 
60 

60 



Casualties 

or 
Damage 



Boican (Mod). Forests (Sev) 

Communication Lines and Ecuipmeot iSrit 

Casualties in Open 

Vehicles (Modi 

Office and Industrial Dldji (Sev) 



Locomotives. Ta-.ks. Arty. Inf W;r.i (Mod) 
Supplies. Packaced (Sev) 

llr.dces (Sev) 



2 -- 



100 



1 ~- 



A-39 



BLAST DAMAGE, LOW AIR BURST 



Yield 
IKT) 


H> (Meters) 


6.000 - 




4.000- 




3.000- 




2.000- 




1.000- 

soo- 




«oo — 




700 — 




too — 




too — 




400 _ 




300- 




200- 




100 — 
90- 
•0 — 




70 — 




(0 — 




to- 




40- 









Radius of Damage 
(Meters) 



to.ooo - 

40.000 _ 




30.000- 





10.000- 

s.ooo • 

1.000 - 
7.00O- 

t.ooo- 

l 000 
4.000 

3.000 - r 



l.ooo -x 



Severe 
Damage 



Psi 



1.000 ■ 

500 - 
100- 
700- 

400 - 

too- 

400- 



200 -± 



Wood Fnmf Howrt 

P.rkrd Aircraft 



Bnck Apartment 



Oil Storace Tjnl» — 

FoJOoU-i. Trcnchc. 
(Ca.ualt.nl 






Casualties 
or 



: Damage 



Boican (Mod), romli (S<») 
Cofniminiratiann L.nn and D-.jipmcnt (Sicv) 

-1- CaiU»!:ir» in Open 

Vrhiriel IMn.ll. Offrt and 
InduatnaJ Uldn (Sc») 



Lnrnnvtii:'*. Tml«. Ar.nlcn 

]r.f Wpm IM-Jl 

Sjppiin. Packlfri (Sc») 



_. Bridtn (S»«) 



A-40 



THERMAL RADIATION, AIR AND SURFACE BURSTS 



Yield R,» 
OCT) (Meters) 



s.ooo — 

4.000 — 
J.OOO — 

2.000 — 



i.ooo- 

900- 
800- 
700- 
SOO- 



100 — 



:oo — 



100 
90 

so 

TO 
iO 



JO — 



20 — 



10 

»• 

8 

7- 
< 
I 
4 — 

J — 



2 — 



Distance 
Slant Range 

•%^ (MetefS) 




10.000 
40.000 

80.000 — 
20.000 



10.000 
♦ 000 
8.000 
7.000 • 
1.000 ' 
1.000 ' 
4.000 - 

8.000 — 
2.000 



• 90.000 
" 80.000 

• 70.000 
' 40.000 

■ (0.000 

■ 40.000 
80.000 

J- 20.000 



10.000 

9.000 

S.OOO 

7.000 

t.000 

S.OOO 

4.000 



1.000 



_E-2.0OO 



200 



100 — ; 



l.ooo — 






900 — 






800 — 






700 — 






soo — 




1.000 


soo — 




900 






800 


400 — 




700 






SOO 


800 — 










600 










s— 


400 



200 



— 200 



Cal/cm* 



Ignition 



Rotter) Wood - 



Fine Cnua, 

Whit* Pine Needle*. 

Deciduouj leave* 

Court* Crvi 
Spruce. Other — 
Pine Neddie* 



Summer Uniform 



Winter Uniform 




I — 100 



J — ' — 



A-41 



COMBINED INITIAL NUCLEAR RADIATION 
AIR AND SURFACE BURSTS 



Total Dou 

(rem) 



(Mctm) 



Yield 



4 



— t?a- 



Inda 






A-42 



GLOSSARY OF TERMS 

ABSORBED DOSE - The energy imparted to matter by ionizing radiation per unit 
mass of irradiated (absorbing) material. The unit of absorbed dose is the 
gray (IGy = 100 rad) . 

ACT I VAT ION - The process of inducing radioactivity by irradiation. 

ACT IVITY — The number of nuclear transformations (disintegrations) in a 
specified time period, usually per second, per minute, etc. 

ACUTE (RADIATION EXPOSURE) - Extending over a period of 24 hours or less. 

ALPHA PARTICLE — A positively charged particle emitted from the nucleus of an 
atom, having a mass equal in magnitude to a helium nucleus. Also generally 
termed alpha radiation. 

AMBIENT PRESSURE - Atmospheric pressure. 

ATOM — The sma I I est part icle of an element that still retains the 

characteristics of that element and which is capable of entering into a 
chemical reaction. 

ATTENUAT ION - The process by which the radiation exposure rate is reduced 
when passing through some material. 

BACKGROUND RADIATION — Nuclear or ionizing radiations arising from within 

the body and from the surroundings to which individuals are always exposed. 
The main sources of natural background radiation are potassium-40 in the 
body, potassium-40 and thorium, uranium, and their decay products 
(including radium) present in rocks and cosmic rays. 

BASIC SKILLS DECONTAMINATION - The immediate neutralization or removal of 
contamination from exposed portions of the skin. Each individual must be 
able to perform this decon without supervision. 

BETA BURNS — Superficial skin injury, simi I ar to a sunburn, caused by beta 
i rrad iat ion. 

BETA PARTICLE — A negatively charged particle having a mass equal to the 
electron. It is emitted spontaneously from the nuclei of certain 
radioactive elements. 

CHAIN REACT ION - In a nuclear weapon the uncontrolled release of neutrons each 
of which interacts with another atom causing a geometric increase in the 
number of fissions. 

CHAMBER, POCKET - A small rechargeable device used for monitoring the 

radiation exposure of personnel. The amount of discharge is a measure of 
the radiation exposure. (An example of this type of instrument is the 
tactical dosimeter IM 93). 

MED447 G-1 



CHARGED PARTICLES - Elementary particles that carry an electric charge, e.g., 
electrons and protons. The nuclei of some light elements are also referred 
to as charged particles: the deuteron, triton, and alpha particle. 

CHEMICAL SURVEY — A directed effort to determine the nature and degree of 
chemical hazard in an area and to set boundaries of the hazard area. 

CHRONIC (RADIATION EXPOSURE) - Exposure to small amounts of radiation 
(< 19 cGy) over a long period of time. 

CLOUD BOTTOM ANGLE - The angle between the surface of the earth and the bottom 
of the stabilized nuclear cloud measured at H + 10 minutes. 

CLOUD TOP ANGLE — The angle between the surface of the earth and the top of 
the stabilized nuclear cloud measured at H + 10 minutes. 

CLOUD WIDTH — The width of the nuclear cloud, measured in degrees or radians, 
determined at H + 5 minutes. 

COLLECTIVE PROTECTION - A shelter, with f i I tered air, that provides a 

contamination free working environment for selected personnel and allows 
relief from continuous wear of MOPP gear. 

CONTAMINAT ION - (1) Deposit or absorption of radioactive material or 
biological agents or chemical agents on and by structures, areas, 
personnel, or objects. (2) Food or water made unfit for human or animal 
consumption by the presence of environmental chemicals, radioactive 
elements, bacteria, or organisms. (3) The byproduct of the growth of 
bacteria or organisms in decomposing material (including the food substance 
itself), or waste, in food or water. 

CONTAMINATION AVOIDANCE - Individual or unit measures taken to avoid or 
minimize NBC attacks and reduce the effects of NBC hazards. Passive 
contamination avoidance measures are concealment, dispersion, deception, 
and the use of cover to reduce the probability of the enemy using NBC 
weapons on your units and minimize damage caused by NBC weapons if they 
are used. Active contamination avoidance measures are: contamination 
control; detection, identification, and marking of contaminated areas; 
issuance of contamination warnings; and relocation or rerouting to an 
uncontami nated area. 

CONTAMINATION. RADIOACTIVE - The presence of radioactive materials where it 
is not desired, particularly where its presence may be harmful. 

COSMIC RAYS - Radiation that originates from sources outside the earth's 
atmosphere and which contributes to the natural background radiation 
present in man's environment. 

CR IT ICAL MASS — The min imum mass of a f issionable mater ia I that wi I I just 
maintain a fission chain reaction under precisely specified conditions, 
such as the nature of the material and its purity, the nature and thickness 
of the tamper (or neutron reflector), the density (or compression), and the 

MED447 G-2 



physical shape (or geometry). For an explosion to occur, the system must 
be supercritical; i.e., the mass of material must exceed the critical mass 
under the existing conditions. 

DECAY — Spontaneous decrease in the number of radioactive atoms in radioactive 
material, by the emission of particle or rays from the atom's nucleus. 

DECAY PRODUCT — A nucl ide resulting from the radioactive disintegrations of a 
radionuclide, formed either directly or as a result of successive 
transformations in a radioactive series. 

DECONTAMINATION (CHEMICAL AND BIOLOGICAL) - Process of making any person, 
object, or area safe by absorbing, destroying, neutralizing, or removing 
chemical agents or biological agents. 

DECONTAMINATION (NUCLEAR) - The reduction or removal of contaminating 
radioactive material from a structure, area, equipment, or person. 
Decontamination may be accomplished by: (1) treating the surface so as to 
remove or decrease the contamination; (2) letting the material stand so 
that the radioactivity is decreased as a result of its natural decay; and 
(3) covering the contamination so as to attenuate or reduce the radiation 
emi tted . 

DELIBERATE DECON — Operations or techniques intended to decontaminate 
clothing and equipment so operators or crew members can perform their 
mission with individual and respiratory protection removed. 

DETECT ION — Discovery, identification, and marking of contaminated areas. 
Detection is the act of finding out by use of chemical detectors or 
• radiological survey instruments the location of NBC hazards placed by the 
enemy. Detectors and instruments are normally operated by NBC monitoring/ 
survey teams. 

PIS INTEGRAT ION - Process of spontaneous breakdown of a nucleus resulting in 
the emission of a particle and/or a photon. 

DOSE — A general term denoting the quantity of radiation or energy absorbed. 
For special purposes it must be appropriately qualified. If unqualified, 
it refers to absorbed dose. (See absorbed dose). 

DOSE RATE - Absorbed dose delivered per unit time (cGy/hour) . 

DOSIMETER - Instrument to detect and measure accumulated radiation exposure. 
The tactical dosimeter is a pencil-size ionization chamber with a self— 
reading electrometer used for personnel monitoring (IM— 93). 

ELECTRON - A particle of very sma I I mass, carrying a negative charge of one. 
Electrons surround the nucleus in all neutral atoms. 

ELECTRON VOLT (eV) A small unit of energy equivalent o the energy gained 
by one electron in passing through a potential difference of 1 volt. 



MED447 G-3 



ENERGY - The ab i I i ty to do work. 

ERYTHEMA - An abnormal redness of the skin, due to an excess of blood in the 
capillaries, caused by a variety of agents, including ionizing radiation. 

EXPOSURE — A measure of the ionization produced in air by x or gamma 

radiation. It is the sum of the electrical charges on all ions of one sign 
produced in air when all electrons liberated by photons in a volume element 
of air are completely stopped in air, divided by the mass of the air in the 
volume element. The special unit of exposure is the "roentgen." 
Abbreviated (R) . 

FALLOUT — The rad ioact i ve debr is, usua My from a nuc I ear detonat ion , wh ich is 
deposited on the earth's surface after having been airborne. Local (or 
early) fallout is defined, somewhat arbitrarily, as those particles which 
reach the earth within 24 hours after a nuclear explosion. Worldwide (or 
delayed) fallout consists of the smaller particles which ascend into the 
upper troposphere and into the stratosphere and are carried by winds to all 
parts of the earth. The worldwide fallout is brought to earth, mainly by 
rain and snow, over extended periods ranging from months to years. Fallout 
emits beta and gamma radiation. (See residual radiation). 

F IREBALL - The luminous sphere of hot gases formed by a nuclear explosion. 

F ISS ION — A nuclear transformation characterized by the spl itting of a nucleus 
into at least two other nuclei and the release of a relatively large amount 
of energy. 

F ISSIONABLE — Refers to isotopes (uranium 235, plutonium 239) which can be 
made to undergo fission easily. 

FISSION FRAGMENT — One of the unstable by— products of the fission process. 
(See fission products, below). 

FISSION PRODUCTS - A general term for the complex mixture produced as a result 
of nuclear fission. A distinction should be made between these and the 
fission fragments. Something like 80 different fission fragments result 
from roughly 40 different modes of fission of a given nuclear species 
(e.g., 235U or 239Pu) . The fission fragments, being radioactive, 
immediately begin to decay, forming additional (daughter) products, with 
the result that the complex mixture of fission products so formed contains 
about 200 different radioisotopes which are either pure beta emitters or 
beta— gamma emitters. 

FLASH TO BANG TIME - The elapsed time between the emission of the bright 

light and the arrival of the blast wave (or sound) of a nuclear detonation. 
Each 3 seconds of flash to bang time corresponds to approximately 1 
k i I ometer of range . 

FLASH BURN — A burn caused by excessive exposure to the radiated heat from 
the fireball of a nuclear explosion. 



MED447 G-4 



FUS ION — The process whereby the nuclei of I ight elements, especial ly 

those of the isotopes of hydrogen (deuterium and tritium), combine to form 
the nucleus of a heavier element with the release of substantial amounts of 
energy. 

GAMMA RADIATION — Electromagnetic radiation originating from the nucleus of 
an atom. 

GEIGER-MUELLER (G-M) SURVEY METER - An instrument consisting of a gas filled 
Ge i ger— Mue I I er tube as the detecting element and accompanying electronic 
circuitry to measure low levels of Beta— Gamma radiation. (AN/PDR— 27) 

GENETIC EFFECT — With respect to radiation exposure, that damage which affects 
the material in the cell associated with reproduction and heredity. By 
definition those effects which appear in future generations of the organism 
irrad iated . 

GRAY (Gy) — Unit of absorbed dose of ionizing radiation equal to 100 rad or 
1 Joule/Kg. 

GROUND ZERO (GZ) — The point on the earth's surface vertical ly below or above 
the center of burst of a nuclear weapon. 

GUN-TYPE WEAPON (OR GUN-ASSEMBLY WEAPON) - A device in which two or more 
pieces of fissionable material, each in a subcritical state, are brought 
together very rapidly so as to form a supercritical mass which can explode 
as the result of a rapidly expanding fission chain reaction. 

H — H represents H— hour , the time of detonation. Time after detonation is 

expressed in hours unless otherwise specified. For example H + 2 refers to 
the time two hours after detonation of a particular nuclear weapon. 

HALF-LIFE. RADIOACTIVE - Time required for 50 percent of the nuclei of 
radioisotope (radionuclide) to disintegrate. 

HALF-VALUE LAYER (HVL) - The thickness of a specified material which, when 

placed in the path of a given beam of X— ray or gamma radiation, reduces the 
exposure rate by one— half. 

HASTY DECON - Action of teams or squads using equipment found within battalion 
sized units to reduce the spread of contamination on people or equipment 
and a I low temporary re I ief from MOPP 4. 

HOB — (Height of Burst) The vertical distance in feet above the surface. 

ILLUMINATION TIME - The per iod of t ime dur ing wh ich the f irebal I from a 
nuclear detonation emits a bright light. 

IMPLOSION-TYPE WEAPON (IMPLOSION WEAPON) - A device in which a quantity of 
fissionable material, in a subcritical state, has its volume suddenly 
decreased by compression so that it becomes supercitical and explodes. The 
compression is achieved by means of a spherical arrangement of specially 

MED447 G-5 



fabricated shapes of ordinary high explosive which produce an inwardly 
directly implosion wave. The fissionable material, being at the center of 
the sphere, is thereby compressed to a supercritical state. 

INDUCED RADIOACTIVITY — Radioactivity produced in previously nonradioactive 
materials as a result of nuclear reactions, particularly the capture of 
neutrons. 

IN IT I AL RAD I AT ION — Nuclear radiation, essentially neutrons and gamma 

radiation, emitted from the fireball and the cloud column during the first 
minute after nuclear detonation. 

ION — An atom or molecule that has lost or gained one or more electrons by 
ionization thereby acquiring an electrical charge. 

ION IZAT ION — The process by which a neutral atom or molecule acquires a 
negative or positive charge. 

IQNIZ ING RAD I AT ION - Any radiation capable of removing electrons from an atom 
either directly or indirectly leaving a positively charged ion. 

I ON PA I R — A closely associated positive ion and negative ion having opposite 
charges of the same magnitude. 

IRRADIAT ION - Exposure to radiation. 

ISOTOPE — Nuclides having equal numbers of protons and thus with identical 
chemical properties but different numbers of neutrons and therefore 
dissimilar nuclear properties. 

KILOTON (KT) - Refers to the energy released by the detonation of 1,000 tons 
of TNT. Normally the energy equivalent of nuclear detonations is expressed 
as KT. 

LASER — Light amp I if ication by stimulated emission of radiation. 

LATENT PERIOD — During the scute radiation syndrome, that period of time 
between the end of the initial effects (prodrome) and the onset of the 
secondary illness, during which the individual appears to recover. 

MACH STEM - A reinforcement of the Shockwave front by the reflected shock- 
wave from the surface. 

MARK I (NAAK) - Nerve Agent Antidote Kit 

MASS — The material equivalent of energy — differs from weight in that it 
neither increases nor decreases with gravitational force. 

MEGATON (MT) — Refers to the equivalent energy release from the explosion of 
a million tons of TNT. (See Kiloton, above; and TNT equivalent, below). 

MON I TOR ING — Periodic or continuous measuring of the dose rate from radio— 

MED447 G-6 



active contamination. 

MOPP — Miss ion— or iented protective posture. A flexible system that provides 
maximum NBC protection for the individual with the lowest risk possible and 
st i I I a I I ow miss ion accompl ishment . 

NBC - Nuclear, Biological, and Chemical 

NBCC - Nuclear, biological, and chemical center. The division NBCC plans for 
and directs the collection effort for NBC hazards information. 

NBCWRS — Nuclear, biological and chemical warning and reporting system. Units 
use the NBCWRS as battlefield intelligence to send and receive NBC 1-6 
reports. 

NEUTRON — An uncharged nuclear particle with a mass approximately equal to 
that of a hydrogen atom. 

NONEFFECT IVE — As appl ied to an individual , one who cannot perform his 
assigned mission or task. 

NONPERS I STENT AGENT — A chemical agent that — when released - dissipates or 
loses its ability to cause casualties after 10 to 15 minutes. 

NUCLEAR RADIATION — Electromagnetic and particulate ionizing radiations which 
originate in the nucleus. 

NUCLEAR REACTION — A process involving a change in the nucleus, such as 

fission, fusion, neutron capture or radioactive decay. It is distinct from 
a chemical reaction which is limited to changes in only the electron 
structure surrounding the nucleus. 

NUCLEAR REACTOR — An assembly of nuclear fuel capable of sustaining a 

controlled chain reaction based on nuclear fission: sometimes called a 
pile. 

NUCLEAR WEAPON (ATOMIC BOMB) - A general name given to any weapon in which the 
explosion results from the energy released by reactions involving atomic 
nuclei, either fission or fusion, or both. Thus the A— (or atomic) bomb and 
the H— (or hydrogen) bomb are both nuclear weapons. It would be equally 
true to call them atomic weapons, since it is energy of the atomic nuclei 
that is involved in each case. However, it has become more or less 
customary, although it is not strictly accurate, to refer to weapons in 
which all the energy results from fission as A— bombs or atomic bombs. To 
make a distinction, those weapons in which part, at least, of the energy 
results from thermonuclear (fusion) reactions among the isotopes of 
hydrogen have been called H— bombs or hydrogen bombs. 

NUCLEUS — The heavy central part of an atom in which most of the mass and the 
total positive electric charge is concentrated. 

NUCLIDE — A general term referring to al I nuclear species, both stable and 

MED447 G-7 



unstable, of the chemical elements, as distinguished from the two or more 
nuclear species of a single chemical element which are called "isotopes." 

OVERPRESSURE - The transient pressure usually expressed in pounds per square 
inch (psi), exceeding existing (ambient) atmospheric pressure and 
manifested in the shock or blast wave from an explosion. 

PEAK OVERPRESSURE — The highest overpressure resulting from the blast wave. 

PERSISTENT AGENT — A chemical agent that — when released — remains in an area 
from hours to days releasing vapors and not losing its ability to cause 
casual t ies. 

PETECH I AE — Small, pinpoint, nonraised, round purplish— red spots caused by 
intradermal or submucosal hemorrhage, which later turn blue or yellow. 

PHOTON — A quantity or "bundle" of electromagnetic energy, usually x or 
gamma r ad i at ion. 

POS ITRON — A positively charge particle equal in mass to the electron. 

PRODROME — The prodrome represents the initial effects from an acute exposure 
to radiation, onset and length of time and severity are dose dependent. 

PROTON (p) — A nuclear particle with a positive electric charge of one. 
Its mass is approximately equal to that of a neutron. 

PURPURA — Large hemorrhagic spots in or under the skin or mucosal tissues. 

QF (QUALITY FACTOR) — A factor which is a function of I inear energy transfer. 
It relates absorbed dose to dose equivalent (rads to rem) (or Gy to Sv) in 
radiation protection. 

RAD I AC — A term devised to designate various type of radiological measuring 
instruments. (Acronym: Radioactivity Detection Judication And 
Computat ion) . 

RAD I AT I ON (IONIZING) — Any electromagnetic or particulate radiation capable 
of producing ions, directly or indirectly, by interaction with matter. 

EXTERNAL RADIATION - Radiation from a source outside the body. 

INTERNAL RADIATION - Radiation from radioactivity deposited within the body. 

RADIATION PROTECTION OFFICER (RPO) - The person designated by the commander 
as responsible for the radiation protection program. 

RADIATION PROTECTION STANDARDS - Radiation doses which should not be exceeded 
without careful consideration of the reasons for doing so. Every effort 
should be made to encourage the maintenance of radiation doses as far below 
these guides as possible. 



MED447 G-8 



RAD I PACT I V ITY — The property of certain unstable nucl ides to spontaneously 
emit particles or gamma radiation or to emit X— radiation following orbital 
electron capture or to undergo spontaneous fission. 

RADIOISOTOPE - An unstable isotope that decays or disintegrates spontaneously, 
emitting radiation. 

RADIUS OF EFFECT - The maximum distance from ground zero at which a specific 
nuclear weapon effect occurs. 

RANGE (NUCLEAR WEAPON EFFECTS) - The horizontal distance from ground-zero 
to which a given weapon effect extends. 

REM (ROENTGEN EQUIVALENT MAN) - The unit of dose equivalent which is the 

product of the dose in cGy and an appropriate modifying factor such as QF 
(radiation protection). 

RESIDUAL NUCLEAR RADIATION - Nuclear radiation, chiefly beta particles and 

gamma rays, which persist for some time following a nuclear explosion. The 
radiation is emitted mainly by the fission products and other bomb residue 
in the fallout, and to some extent by earth and other materials in which 
radioactivity has been induced by the capture of neutrons. 

ROENTGEN (R) — The unit of exposure of X or gamma radiation in air. 

SECONDARY BLAST INJURIES - Those injuries sustained from the indirect blast 
effects, such as from rubble from a col I apsed bu i Id i ng or from miss i I es 
(debris or objects) which have been picked up by the winds generated and 
hurled against an individual. Also includes injuries resulting from 
individuals being hurled against stationary objects. (Sometimes referred 
to as tertiary effect.) 

SECONDARY I LLNESS - The man i f est ill ness phase of acute radiation injury 
which takes on the signs and symptoms associated with injury to the 
critical organ system. 

SH I ELD - A material used to prevent or reduce the passage of radiation. 

SOMATIC EFFECTS OF RADIATION - A general term for al I effects caused or 

induced by ionizing radiation which manifest themselves during the lifetime 
of the individual receiving the radiation dose (as opposed to genetic 
effects) . 

STABLE ISOTOPE - An isotope that does not undergo radioactive decay. 

SUPERCRITICAL - The term appl ied to f issionable mater ial wh ich has been 
altered from the critical state (by a change in its mass, density, or 
shape, or by tamping) to a condition in which the neutrons produced inside 
the material increase rapidly and uncontrollably to produce a nuclear 
explosion. The number of fissions increase geometrically, and the neutrons 
produced there by will sustain an increasing or multiplying chain reaction. 

SURVEY METER - Any portable radiation detection instrument especially adapted 

MED447 G-9 



for surveying or monitoring an area, structure, personnel, clothing, or 
equipment to establish the existence and amount of radioactive material 
present . 

SYMPTOM — Any functional evidence of disease or of a patient's condition. 

SYNDROME - A set of symptoms which occur together. 

TAMPER — Material surrounding the fissionable material in a nuclear weapon 

for the purpose of holding the supercritical assembly together by its 

inertia and for reflecting neutrons, thus increasing the number of fissions 
in the active material. 

THERMAL RADIATION — E I ectromagnet ic radiation emitted from the fire ba I I as 
a consequence of its very high temperature. It consists essentially of 
ultraviolet, visible, and infrared radiation. 

THERMONUCLEAR (THERMONUCLEAR WEAPONS) - An adjective referring to the process 
(or processes) in which very high temperatures are used to bring about the 
fusion of light nuclei, such as those of the hydrogen isotopes (deuterium 
and tritium), with the accompanying liberation of energy. A thermonuclear 
bomb is a weapon in which part of the explosion energy results from 
thermonuclear fusion reactions. The high temperatures required may be 
obtained by means of a fission explosion. 

THERMONUCLEAR BOMB (DEVICE) - A hydrogen bomb. 

TNT EQUIVALENT — A measure of the energy released in the detonation of a 
nuclear explosive expressed in terms of the weight of TNT which would 
release the same amount of energy when exploded. It is usually expressed 
in kilotons or megatons. The TNT equivalence relationship is based on the 
fact that 1 ton of TNT releases 1 billion calories of energy. 

UNSTABLE ISOTOPE - A radioisotope. 

WEAPON EFFECTS — The damage or casualty producing agents, specifically blast, 
thermal radiation, and nuclear radiation, resulting from a nuclear 
exp I os i on . 

WEAPONS SYSTEM - The combination of the weapon (or warhead), the fire control 
system, and the carrier. 

X— RAYS — Short wavelength electromagnetic radiation identical to gamma 

radiation, but its origin is in the electron shell of the atom. (See gamma 
rad i at i on) . 

YIELD (OR ENERGY YIELD) - The total effective released in a nuclear (or 
atomic) explosion. It is usually expressed in terms of the equivalent 
tonnage of TNT required to produce the same energy release in an explosion. 
See: TNT equivalent. 

ZONE I (NUCLEAR) — That fallout area downwind from a nuclear detonation where 

MED447 G-10 



troops may receive 150 cGy or more within 4 hours after the arrival of 
fal lout. 

ZONE I (BIOLOGICAL) — The area in which casualties among unprotected personnel 
will be high enough (greater than 20%) to cause significant disruption, 
disability, or elimination of unit operations of effectiveness. 

ZONE I I (NUCLEAR) — The fal lout area where troops may receive 50 cGy or more 
in 24 hours after the arrival of fallout. 

ZONE I I (B I0L0GICAL) — That area downwind from a biological agent release when 
hazards to unprotected personnel are likely to exceed negligible risk 
levels (1 — 3% casualties) under an aerosol disseminated attack. This zone 
may be very large; under some conditions encompassing thousands of square 
k i I ometers. 



MED447 G-11 



CORRESPONDENCE COURSE OF 
THE ACADEMY OF HEALTH SCIENCES, U.S. ARMY 

EXAMINATION 



SUBCOURSE MED447 



--Medical Aspects of Nuclear Weapons 
and Their Effects on Medical Opera- 
t ions. 



CREDIT HOURS 
TEXT ASSIGNMENT 
MATERIALS REQUIRED 



— 21 . 

— Subcourse MED447. 

--You may use the text furnished with 
this subcourse in accomplishing this 
exami nat ion. 



SUGGESTION — Check to see that your computerized 

answer sheet is for edition of 
Subcourse MED447. Inform Extension 
Services Division, AHS, of any 
mismatch so that you will receive the 
correct grade. 

THIS EXAMINATION CONTAINS 50 ITEMS 

REQUIREMENT. Each of the following questions or incomplete statements is 
followed by a group of lettered responses. Select the ONE response that BEST 
answers the question or completes the statement. On the answer sheet, blacken 
the space corresponding to the letter of your choice. 



Examination questions 1 through 5 are matching questions. Match the column A 
items with the appropriate column B option. 





Column A 


1 . 


Gy. 


2. 


AN/PDR-27 


3. 


Mark 1 . 


4. 


MOPP. 


5. 


Dos imeter 



Co I umn B 

a. IM-93UD. 

b. Nerve Agent Antidote Kit. 

c. Flexible system that provides 
maximum NBC protection for the 

individual and still allows 
mission accomplishment. 

d. Used to measure Beta— Gamma 
rad iat ion. 

e. Unit of absorbed dose of 
ionizing radiation equal to 
100 rad. 



MED447 



EXAM-1 



6. In the atom of uranium, 23S U, there are protons, 



»: 



neutrons, and nucleons, respectively 



a. 238, 146, and 92. 

b. 92, 146, and 238. 

c. 146, 92, and 238. 

d. 330, 238 and 146. 

7. The symptoms of the prodromal phase of the hematopoietic and 
gastrointestinal forms of acute radiation syndrome are about the same except 
that the symptoms of the gastrointestinal form are more: 

a. Severe and more rapidly appearing. 

b. Characteristic of acute infection or septicemia. 

c. Likely to include a longer latent period. 

d. Easily distinguished from those of the central nervous system 
form. 

8. If a person absorbed a whole body, acute, ionizing radiation dose of 
over 3,000 rad, his first obvious symptoms of radiation sickness would be 
those of the form of the acute radiation syndrome. 

a. Hematopoietic. 

b. Gastro i ntest ina I . 

c. Cerebra I . 

9. For medical planning purposes, about how long after a nuclear attack 
will the major portion of those injured in a target city have to get along 
without organized medical help? 

a. 1 day. 

b. 3 days. 

c. 20 days. 

d. 60 days. 



MED447 EXAM-2 



10. In the management of mass casualties, there will be great disparity 
between the extent of the problem and medical means to solve it. This 
disparity exists in three main areas. All of the following, EXCEPT that in 
choice depict these areas. 

a. The fear of people to become involved. 

b. The enormous workload. 

c. Necessary supplies and medical facilities in short supply. 

d. Lack of trained personnel. 

11. Under disaster conditions, which of the following tasks may be 
performed by an MSC officer for patients who are in need of the services 
I isted? 

a. Assisting in major surgery. 

b. Performance of circulating nurse duties. 

c. Rendering preoperative and postoperative care. 

d. Establishment of an emergency airway. 

12. Immediately following a nuclear explosion, casualties should be 
sorted into four categories for treatment, evacuation, or return to duty. 
What category of patients should given first priority? 

a. Immediate. 

b. Expectant. 

c. Delayed. 

d . Mi n imal . 

13. In a nuclear weapons detonation, the greatest percentage of released 
energy is in the form of: 

a. Blast or shock wave. 

b. Thermal radiation. 

c. Nuclear radiation. 



MED447 EXAM-3 



14. What probable effects will be caused by exposure to an acute dose of 
100 rad or less in 24 hours of either initial or residual nuclear radiation? 

a. Immed iate death. 

b. CNS form of radiation illness. 

c. No clinical evidence of disease. 

d. Nausea and vomiting with blood changes. 

15. Which of the following blasts produces fallout? 

a. Airburst. 

b. Surface burst. 

c. Subsurface burst. 



16. A burn which is characterized by blister formation is a 
degree burn. 



a . First. 

b. Second. 

c . Th i rd . 

17. Which of the following factors has (have) any effect on the amount of 
thermal radiation from a nuclear weapon detonation? 

a. Weapon size. 

b. Altitude of detonation of the weapon. 

c. Atmospheric conditions. 

d . All of the above. 



MED447 EXAM-4 



18. What is one limiting factor in the use of experience gained from 
patients who have been treated successfu I I y wi th clinical radiotherapy? 

a. The number of cases is too small. 

b. The cases are poorly documented. 

c. The treatments had little, if any, whole body effects. 

d. The doses were larger than those which might be encountered under 
warfare conditions. 

19. The time period after the onset of a mass casualty situation is 
divided into four phases. Phase II involves: 

a. 3 days. 

b. From 3 to 20 days. 

c. From 20 to 60 days. 

d. 60 days and more. 

20. Which of the following is the most sensitive to the acute radiation 
i njury? 

a. Parenchymal cells of liver and kidney. 

b. Nerve eel Is. 

c . Muse le ce I Is. 

d. Bone marrow. 

21. What is the probable range of absorbed dose for the classification of 
hematopoietic form of the acute radiation syndrome? 

a. 0-100 rad. 

b. 200 - 800 rad. 

c. 800 - 3000 rad. 

d. 3000 rad and up. 



MED447 EXAM-5 



22. In the classification of the acute radiation syndrome which follows 
irradiation, certain assumptions are made. All of the following, EXCEPT that 
in choice are valid assumptions for the discussion in the Subcourse. 

a. There has been no significant prior or concomitant injury. 

b. The body is uniformly irradiated. 

c. The individual is average. 

d. All doses are received over a considerable period of time. 

23. What is the probable range of absorbed dose, if any, for the disease 
classification of "No obvious disease"? 

a. There is no absorbed radiation. 

b. to 100 rad. 

c. 200 - 500 rad. 

d. 500 - 1000 rad. 

24. The typical hematopoietic form of the acute radiation syndrome is 
characterized by all of the phases below, EXCEPT that in choice . 

a. Gastrointestinal. 

b . Prodroma I . 

c. Latent. 

d. Bone marrow depression. 

e. Recovery. 

25. During which phase of the acute hematopoietic syndrome should you 
expect to see epilation? 

a . Prodroma I . 

b. Latent. 

c. Bone marrow depression. 

d. Recovery. 

e. None of the above. 

MED447 EXAM-6 



26. All of the following, EXCEPT that in choice are initial 

symptoms of the prodromal phase of the acute hematopoietic syndrome. 

a. Fatigue. 

b. Lethargy, 
c . Anorex i a . 
d. Diarrhea. 

27. You are 900 meters away from a 10 KT nuclear weapons detonation 
(surface burst) in an exposed location. What degree of thermal burns would 
you expect? 

a. F irst . 

b. Second. 

c . Th ird . 

28. Which of the following results would you expect from a 10 KT weapon, 
low airburst, if you were 1000 meters away from ground zero? Severe damage to 

a. An adjacent brick apartment house. 

b. Foxholes. 

c . Oil storage tanks. 

d. Underground bunkers. 

29. You are in an exposed location when you see the reflected 
illumination from a nuclear weapons detonation. The illumination lasts about 
9 seconds. The yield of this weapon is about KT . 

a. 125. 

b. 160. 

c. 200. 

d. 475. 



MED447 EXAM-7 



30. Which of the following "paints" a true picture of the bone marrow 
depression phase of the acute hematopoietic syndrome? 

a. Hemorrhagic fever. 

b. Lymphopenia. 

c. Acute aplastic anemia. 

d. Leukocytosis. 

31. You are in a foxhole when there is an outside reading for residual 
radiation of 500 rad/hr. What is the rate inside the foxhole? 

a. 450 rad/hr. 

b. 250 rad/hr. 

c. 50 rad/hr. 

d. 5 rad/hr. 

32. Which of the following choices describes the gamma ray? 

a. A particle of electromagnetic radiation originating from the 
nucleus of an atom with energy from 10 keV to approximately 20 MeV. 

b. The negatively charged particle surrounding the nucleus of an 
atom. 

c. The unit of absorbed dose of any ionizing radiation. 

d. A nuclear particle with a charge which is electrically neutral 
and with a mass approximately equal to that of a hydrogen atom. 

33. Which of the following field radiac equipment is used to survey an 
area for gamma dose rate in a range of to 500 rad/hr? 

a. IM 9/PD. 

b. IM 174A/PD. 

c. IM 93/UD. 

d. IM 147/PD. 



MED447 EXAM-8 



34. If you have an effective wind speed of 20 kmph and a yield of 100 KT , 
the downwind distance of Zone I for a surface burst would be about: 

a. 13 km. 

b. 35 km. 

c. 45 km. 

d. 90 km. 



35. In the plan recommended by the American Medical Association for 
providing organized medical care under disaster conditions, what will be the 
role of each paramedical worker? 

a. To perform his regular patient care tasks for a larger number of 
pat ients. 

b. To perform tasks ordinarily reserved for one of higher 
professional license in patient care and treatment. 

c. To supervise untrained personnel in the performance of all 
medical care tasks. 

d. To develop instructional materials for use in case of disaster. 



36. If the radiation dose rate at H + 1 is 4,500 rad/hr, what will be the 
dose rate at H + 7? 

a. 450. 

b. 400. 

c. 250. 

d. 125. 

37. If the radiation dose rate at H + 1 is 600 rad/hr, what will the dose 
rate be at H + 2? 

a. 370. 

b. 350. 

c. 300. 

d. 270. 



MED447 EXAM-9 



38. Which of the three methods used in calculating doses and dose rates 
is the least accurate method? 

a. ABC-MI Radiac Calculator. 

b. Rules of thumb. 

c. Nomograms. 



39. Of what would the treatment for patients in the expectant category 
cons ist? 

a. Resuscitation and as much emergency medical treatment as 
facilities, supplies, and professional personnel permit. 

b. Delayed treatment with possible complications resulting but no 
jeopardy to I i f e. 

c. Relatively short procedures. 

d. Minimum treatment with return to duty. 



40. In a mass casualty situation, the patients falling into the minimal 
category would be about percent of the total patient load. 

a. 20. 

b. 30. 

c. 40. 

d. 50. 

41. In a mass casualty situation, patients who have open fractures of 
major bones will be placed in the category. 

a. Immediate. 

b. M i n ima I . 

c. Delayed. 

d. Expectant. 



MED447 EXAM- 10 



42. In a mass casualty situation, a typical sorting team is composed of: 

a. A physician, a dental officer, and 12 to 15 - medical specialists. 

b. Two physicians, 3 dental officers, and 2 to 3 medical specialists 

c. Three physicians, 2 dental officers, and 4 or 5 medical 
spec ial ists. 

d. All available physicians, dental officers, nurses, veterinarians, 
and medical specialists. 

43. It is now 1600 hours, Greenwich Mean Time. What time is it in San 
Antonio, Texas? 

a. 1600 hours. 

b. 1200 hours. 

c. 1000 hours. 

d. 0800 hours. 

44. Refer to the map and overlay. Which of the following units is 
outside of both Zone I and Zone II? 

a. Hq, 36th Inf Div. 

b. 1st Bn, 504th Armor . 

c. 36th DISC0M. 

d. 98th Combat Support Hospital. 

45. In the map exercise, how was the 6 km distance from the Engineer Bn 
to GZ found? 

a. From the illumination time. 

b. From the Effective Downwind Message. 

c. From the f I ash— to— bang time. 

d. None of the above. 



MED447 EXAM- 11 



Examination questions 46 through 50 are matching questions. Match the column 
A items with the appropriate column B option. 



Co I umn A 



Co I umn B 



46. 100 rad or less in 24 hours 

47. More than 300 rad delivered 
in less than an hour. 



a. 50% require MEDVAC in less 
than 24 hours. 

b. 90% vomiting in 6 hours. 



48. 500-1000 rad in 24 hours. 

49. 350-450 rad gradually over 
1 year . 

50. 100-200 rad in less than 
24 hours. 



No evacuation for temporary 
i I I ness. 

Decreased efficiency and 
increased susceptibility to 
trauma and late effects. 

No ineffectiveness. 



END OF EXAMINATION 



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MED447 



EXAM- 12 



ACADEMY OF HEALTH SCIENCES, U.S. ARMY 
Fort Sam Houston, Texas 78234-6100 

COMMENT SHEET 

SUBCOURSE NUMBER MED447 EDITION DATE JUNE 1990 

TITLE MEDICAL ASPECTS OF NUCLEAR WEAPONS AMD THEIR EFFECTS ON MEDICAL OPERATIO NS 

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